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A positive SeHCAT test results in fewer subsequent investigations in patients with chronic diarrhoea
James M Turner1, Sanjeev S Pattni1,2, Richard N Appleby1
1Division of Digestive Diseases, Imperial College London, Imperial College Healthcare, London, UK.
Insights
Diagnosing bile acid diarrhoea with a SeHCAT test significantly reduces the need for further investigations. This helps avoid unnecessary tests for patients with chronic diarrhoea.
Area of Science:
- Gastroenterology
- Diagnostic Medicine
Background:
- Chronic diarrhoea affects many patients and often stems from various underlying disorders.
- Bile acid diarrhoea (BAD) is a common cause, present in about one-third of chronic diarrhoea cases, yet frequently remains undiagnosed.
- Undiagnosed BAD leads to extensive and often unnecessary diagnostic workups.
Purpose of the Study:
- To investigate if a positive diagnosis of bile acid diarrhoea using selenium homocholic acid taurine (SeHCAT) testing reduces subsequent diagnostic investigations.
- To compare the number of investigations performed in patients with confirmed BAD versus those without.
Main Methods:
- A retrospective analysis was conducted on patients previously enrolled in a chronic diarrhoea study.
- Selenium homocholic acid taurine (SeHCAT) test results and subsequent follow-up data from the following 5 years were analyzed.
- The numbers of defined investigations were compared between SeHCAT-positive (BAD) and SeHCAT-negative (idiopathic diarrhoea) groups.
Main Results:
- 90 patients were identified: 36 with primary BAD (SeHCAT retention <15%) and 54 with idiopathic diarrhoea (SeHCAT retention >15%).
- While endoscopic procedures were similar, SeHCAT-negative patients underwent significantly more other investigations, including imaging (CT, MRI, ultrasound) and blood tests (p=0.037).
- SeHCAT-positive patients attended more clinic appointments (p=0.013), suggesting a more focused diagnostic pathway.
Conclusions:
- A positive SeHCAT test for bile acid diarrhoea leads to a significant reduction in the utilization of diagnostic investigations over a 5-year period.
- This highlights the diagnostic value of SeHCAT testing in streamlining patient management and reducing healthcare costs.
- Prompt diagnosis of BAD via SeHCAT testing can prevent unnecessary and costly investigations for chronic diarrhoea.
Abstract:
Chronic diarrhoea is a common condition, resulting from a number of different disorders. Bile acid diarrhoea, occurring in about a third of these patients, is often undiagnosed. We hypothesised that a positive diagnosis of bile acid diarrhoea would reduce the need for subsequent investigations for alternative diagnoses.
Methods:
Patients previously recruited to a study of chronic diarrhoea who had selenium homocholic acid taurine (SeHCAT) testing and subsequent follow-up at our institution were identified. In a retrospective analysis, the numbers of defined investigations undertaken from the first 3 months after SeHCAT in the following 5 years were compared.
Results:
90 patients were identified with primary bile acid diarrhoea (SeHCAT retention <15%, n=36) or idiopathic diarrhoea (SeHCAT retention >15%, n=54). Follow-up had been performed on 29 and 39 subjects, respectively, with no differences in previous investigations or the last contact date. In the follow-up period, the proportions of these patients who had undergone endoscopic procedures (gastroscopy, colonoscopy and sigmoidoscopy) were the same. However, there was a higher proportion of patients in the SeHCAT-negative group who had other investigations, including imaging, physiological tests and blood tests (p=0.037). The use of cross-sectional imaging was significantly higher in this group (p=0.015) with greater proportions having CT (0.44 vs 0.10) and MRI (0.26 vs 0.07). Ultrasound use and the number of blood tests were higher in the SeHCAT-negative group whereas the SeHCAT-positive group attended more clinic appointments (p=0.013).
Conclusion:
A positive diagnosis of bile acid diarrhoea, made by a SeHCAT test, resulted in reduced use of diagnostic investigations over the subsequent 5 years.
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