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Challenging current views on bile acid diarrhoea and malabsorption
  1. Matthew Kurien1,
  2. Elizabeth Thurgar2,
  3. Ashley Davies2,
  4. Ron Akehurst2,
  5. Jervoise Andreyev3
  1. 1 Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Sciences, University of Sheffield, Sheffield, UK
  2. 2 BresMed Health Solutions, Sheffield, UK
  3. 3 The GI and Nutrition Team, The Royal Marsden NHS Foundation Trust, London, UK
  1. Correspondence to Dr Matthew Kurien, Senior Clinical Lecturer in Gastroenterology, Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Sciences, University of Sheffield, Sheffield S10 2RX; matthew.kurien{at}


Background In 2012, the National Institute for Health and Care Excellence (NICE) assessed guidance (DG7) on the use of tauroselcholic (75selenium) acid (also known as SeHCAT) for the investigation of diarrhoea due to bile acid malabsorption (BAM) in patients with IBS-D and in patients with Crohn’s disease who have not had an ileal resection. NICE concluded that tauroselcholic (75selenium) acid was recommended for use in research only. NICE will be reviewing the decision to update the guidance for tauroselcholic (75selenium) acid, for these populations, in March 2017.

Aim Our aim is to summarise advances in BAM, also known as bile acid diarrhoea (BAD), and encourage clinicians to re-evaluate their understanding of this disorder.

Approach We review the prevalence, diagnosis and treatment of BAD/BAM. We describe the new evidence available since the original NICE review in 2012, and discuss the economic issues associated with failure to diagnose or to treat BAD/BAM accurately.

Evidence update There is new and compelling evidence available since DG7, which shows that tauroselcholic (75selenium) acid scanning is a powerful tool in the diagnosis of BAD/BAM. We summarise published prevalence data (approximately 1% prevalence in the UK, as suggested by clinical practice diagnosis rates), and highlight that the true prevalence of BAD/BAM could be far greater than this.

Conclusion We present evidence that challenges current opinion about this disorder, and we commend both clinicians and health technology assessment (HTA) agencies for being open to arguments and new evidence in any future HTAs.

  • diarrhoea
  • bile
  • malabsorption
  • cost-effectiveness

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  • Contributors The contents of the manuscript are our original work and are not under consideration for publication elsewhere. We have adhered to the ICMJE criteria for authorship and have followed the journal guidelines for manuscript development. All authors have read and approved this version of the manuscript.

  • Funding Financial support for this study was provided by GE Healthcare.

  • Competing interests Financial support for this study was provided by General Electric (GE) Healthcare. The funding agreement ensured the authors’ independence in designing the study, interpreting the literature and writing the manuscript. The authors AD, ET and RA are employed by BresMed, which was reimbursed by GE Healthcare as a consultancy for its time developing the manuscript. JA reports personal fees and non-financial support from GE Healthcare, from Sanofi Aventis, during the conduct of the study. MK has no potential conflicts to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.