Original article
Alimentary tract
High Prevalence of Idiopathic Bile Acid Diarrhea Among Patients With Diarrhea-Predominant Irritable Bowel Syndrome Based on Rome III Criteria

https://doi.org/10.1016/j.cgh.2015.03.002Get rights and content

Background & Aims

Some studies have found that patients with idiopathic bile acid diarrhea (BAD) present with symptoms of diarrhea-predominant irritable bowel syndrome (D-IBS). However, these studies either were retrospective, did not define D-IBS according to current criteria, or included patients with chronic functional diarrhea. We performed a prospective study of the prevalence of idiopathic BAD in consecutive patients fulfilling the Rome III criteria for D-IBS.

Methods

We analyzed data from 118 consecutive adult patients who fulfilled the Rome III criteria for D-IBS (mean age, 41.7 y; 72.9% female), seen at 2 gastroenterology clinics in the United Kingdom. We excluded patients with risk factors for BAD (previous history of cholecystectomy, terminal ileal Crohn’s disease, terminal ileal resection or right hemicolectomy, pelvic or abdominal radiotherapy, celiac disease, or microscopic colitis). Participants completed questionnaires at baseline (on demographics, hospital anxiety, somatization, and depression, as well as the patient health questionnaire-12 and the Short Form-36), and then received the 75selenium homocholic acid taurine retention test. Retention of 75selenium homocholic acid taurine 7 days after administration was used to identify patients with idiopathic BAD (mild BAD, 10%−14.9%; moderate BAD, 5.1%–9.9%; and severe BAD, ≤5%).

Results

Twenty-eight patients were found to have BAD (23.7% of total), with similar percentages at each study site (25.3% and 20%; P = .54). Eight patients had mild BAD (28.6%), 8 patients had moderate BAD (28.6%), and 12 patients had severe BAD (42.8%). There was no statistical difference in age, sex, depression, patient health questionnaire-12 responses, or SF-36 scores between individuals with vs without BAD. However, patients with BAD had a higher mean body mass index than patients without BAD (31.6 vs 26.4; P = .003). Physical activity (based on the Short Form-36) was significantly lower in subjects with moderate (43.8) or severe BAD (41.7), compared with patients with mild BAD (87.5) (P = .046).

Conclusions

Almost 25% of patients presenting with D-IBS have idiopathic BAD; most cases are moderate to severe. Guidelines should advocate testing to exclude BAD before patients are diagnosed with D-IBS.

Section snippets

Participants and Setting

This prospective dual-center study was performed at the Royal Hallamshire Hospital (Sheffield, South Yorkshire, UK) and St. James’s University Hospital (Leeds, West Yorkshire, UK). Both are located in northern England and provide secondary care services to a local population of 500,000 and 800,000 people, respectively. On average, each of the general luminal gastroenterology clinics that took part in this study sees 200 new outpatients per gastroenterologist per year, with diarrhea and

Results

A total of 127 consecutive individuals meeting the Rome III criteria for D-IBS were approached, and 118 (92.9%) participated in the study: 83 individuals from Sheffield and 35 individuals from Leeds. Combined data analysis from both sites showed the mean age of D-IBS patients to be 41.7 years, with 72.9% (n = 86) women, 91.5% (n = 108) Caucasian, with a mean body mass index (BMI) of 27.6. The mean scores for assessments of well-being were as follows: Hospital Anxiety and Depression

Discussion

This study has shown that almost 1 in 4 individuals presenting for secondary care who fulfill Rome III criteria for D-IBS have evidence of idiopathic BAD. Furthermore, in nearly 70% of cases the severity of BAD was within the moderate to severe category, and was associated with significant physical role limitations, compared with patients with only mild BAD. We also found that individuals with BAD had a significantly higher mean BMI compared with patients without BAD. These findings have

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    Conflicts of interest These authors disclose the following: David Sanders and Alexander Ford have received grant support and speakers’ fees from GE Healthcare. The remaining authors disclose no conflicts.

    Funding Supported by GE Healthcare.

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