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International Journal of Colorectal Disease

, Volume 34, Issue 1, pp 185–188 | Cite as

Brief report: length of ileal resection correlates with severity of bile acid malabsorption in Crohn’s disease

  • Thomas Skouras
  • Susanna Dodd
  • Yash Prasad
  • Joseph Rassam
  • Nazreen Morley
  • Sreedhar SubramanianEmail author
Short Communication
  • 107 Downloads

Abstract

Purpose

Bile acid malabsorption (BAM) is a common cause of diarrhoea in Crohn’s disease (CD) patients with ileal resection. BAM is usually diagnosed by selenium-labelled homotaurocholic acid test (75SeHCAT) but its availability is limited. Consequently, a large proportion of patients either remain undiagnosed or subject to empirical therapy. There is a paucity of studies examining the correlation between length of ileal resection and severity of BAM, which will be of use to clinicians with no recourse to diagnostic testing for BAM.

Methods

We tested the correlation between length of resected ileum and percentage retention on 75SeHCAT of all CD patients with a prior surgical resection who underwent 75SeHCAT testing. Response to treatment with bile salt sequestrant and 75SeHCAT retention values was tested using Fisher’s exact test.

Results

A total of 91 patients were identified with a median age of 47 (IQR 21-80). The median length of resected ileum was 24 cm (range 15–165 cm) with a median of 1 resection (range 1–4). Overall, 88 patients (97%) had 75SeHCAT retention values of < 10% and 85 (93%) had retention of < 5%. There was a modest correlation between 75SeHCAT retention and length of ileal resection (Spearman’s rho − 0.392, P = 0.0001). Data on response to treatment was available for 57 (63%) patients, of who 38 (67%) responded to bile salt sequestrant. There was no difference in 75SeHCAT retention values between responders and non-responders.

Conclusions

There was a modest correlation between length of ileal resection and severity of BAM as defined by 75SeHCAT retention values. Response to bile salt sequestrant therapy was not dependent on 75SeHCAT retention values.

Keywords

Inflammatory bowel disease Crohn’s disease Ileal resection Bile acid malabsorption 

Notes

Author contributions

TS, YP, JR and NM were involved in data collection. SD conducted the data analysis. All authors were involved in drafting and final revision of the manuscript.

Compliance with ethical standards

Conflict of interest

TS, SD, YP, JR and NM have no conflicts of interest. SS has received speaker fee from MSD, Actavis, Abbvie, Dr. Falk pharmaceuticals, Shire and received educational grant from MSD, Abbvie, Actavis and is an advisory board member for Abbvie, Dr. Falk pharmaceutics, Janssen and Vifor pharmaceuticals.

References

  1. 1.
    Goldberg PA, Wright JP, Gerber M, Claassen R (1993) Incidence of surgical resection for Crohn’s disease. Dis Colon Rectum 36(8):736–739CrossRefPubMedGoogle Scholar
  2. 2.
    Chadwick VS, Modha K, Dowling RH (1973) Mechanism for hyperoxaluria in patients with ileal dysfunction. N Engl J Med 289(4):172–176.  https://doi.org/10.1056/NEJM197307262890402 CrossRefPubMedGoogle Scholar
  3. 3.
    Vitek L, Carey MC (2012) New pathophysiological concepts underlying pathogenesis of pigment gallstones. Clin Res Hepatol Gastroenterol 36(2):122–129.  https://doi.org/10.1016/j.clinre.2011.08.010 CrossRefPubMedGoogle Scholar
  4. 4.
    Lenicek M, Duricova D, Komarek V, Gabrysova B, Lukas M, Smerhovsky Z, Vitek L (2011) Bile acid malabsorption in inflammatory bowel disease: assessment by serum markers. Inflamm Bowel Dis 17(6):1322–1327.  https://doi.org/10.1002/ibd.21502 CrossRefPubMedGoogle Scholar
  5. 5.
    Vijayvargiya P, Camilleri M, Shin A, Saenger A (2013) Methods for diagnosis of bile acid malabsorption in clinical practice. Clin Gastroenterol Hepatol 11(10):1232–1239.  https://doi.org/10.1016/j.cgh.2013.04.029 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Wilcox C, Turner J, Green J (2014) Systematic review: the management of chronic diarrhoea due to bile acid malabsorption. Aliment Pharmacol Ther 39(9):923–939.  https://doi.org/10.1111/apt.12684 CrossRefPubMedGoogle Scholar
  7. 7.
    Camilleri M (2014) Advances in understanding of bile acid diarrhea. Expert Rev Gastroenterol Hepatol 8(1):49–61.  https://doi.org/10.1586/17474124.2014.851599 CrossRefPubMedGoogle Scholar
  8. 8.
    Kovar J, Lenicek M, Zimolova M, Vitek L, Jirsa M, Pitha J (2010) Regulation of diurnal variation of cholesterol 7alpha-hydroxylase (CYP7A1) activity in healthy subjects. Physiol Res 59(2):233–238PubMedGoogle Scholar
  9. 9.
    Lenicek M, Juklova M, Zelenka J, Kovar J, Lukas M, Bortlik M, Vitek L (2008) Improved HPLC analysis of serum 7alpha-hydroxycholest-4-en-3-one, a marker of bile acid malabsorption. Clin Chem 54(6):1087–1088.  https://doi.org/10.1373/clinchem.2007.100107 CrossRefPubMedGoogle Scholar
  10. 10.
    Merrick MV, Eastwood MA, Ford MJ (1985) Is bile acid malabsorption underdiagnosed? An evaluation of accuracy of diagnosis by measurement of SeHCAT retention. Br Med J (Clin Res Ed) 290(6469):665–668CrossRefGoogle Scholar
  11. 11.
    Nyhlin H, Merrick MV, Eastwood MA (1994) Bile acid malabsorption in Crohn's disease and indications for its assessment using SeHCAT. Gut 35(1):90–93CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Aldini R, Roda A, Festi D, Sama C, Mazzella G, Bazzoli F, Morselli AM, Roda E, Barbara L (1982) Bile acid malabsorption and bile acid diarrhea in intestinal resection. Dig Dis Sci 27(6):495–502CrossRefPubMedGoogle Scholar
  13. 13.
    Williams AJ, Merrick MV, Eastwood MA (1991) Idiopathic bile acid malabsorption--a review of clinical presentation, diagnosis, and response to treatment. Gut 32(9):1004–1006CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Eusufzai S, Axelson M, Angelin B, Einarsson K (1993) Serum 7 alpha-hydroxy-4-cholesten-3-one concentrations in the evaluation of bile acid malabsorption in patients with diarrhoea: correlation to SeHCAT test. Gut 34(5):698–701CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of GastroenterologyRoyal Liverpool and Broadgreen University Hospitals NHS TrustLiverpoolUK
  2. 2.Department of BiostatisticsUniversity of LiverpoolLiverpoolUK

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