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Related Experiment Videos

Idiopathic bile acid malabsorption: long-term outcome

W Luman1, A J Williams, M V Merrick

  • 1Department of Gastroenterology and Nuclear Medicine, Western General Hospital, Edinburgh, UK.

European Journal of Gastroenterology & Hepatology
|July 1, 1995
PubMed
Summary

Idiopathic bile acid malabsorption (IBAM) can cause chronic diarrhoea. Long-term follow-up shows spontaneous remission in 50% of patients, while others require ongoing treatment for symptom control.

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Area of Science:

  • Gastroenterology
  • Clinical Medicine
  • Diagnostic Imaging

Background:

  • Idiopathic bile acid malabsorption (IBAM) is a rare condition presenting as chronic diarrhoea.
  • The natural history and long-term outcomes of IBAM have not been well-documented.
  • Exclusion of malignancy and inflammatory bowel disease is crucial before diagnosing IBAM.

Purpose of the Study:

  • To determine the long-term outcome of severe idiopathic bile acid malabsorption.
  • To assess symptom resolution and treatment requirements over time.
  • To evaluate objective markers of bile acid malabsorption using 75Se-homocholic acid taurine (75SeHCAT) retention.

Main Methods:

  • A cohort of 23 patients diagnosed with IBAM in 1989 was studied.
  • Long-term follow-up involved subjective assessment via questionnaires and objective assessment using 75SeHCAT scans.

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  • Patients had previously responded to bile acid chelator therapy (cholestyramine or aluminium hydroxide).

    • Main Results:

    • After a mean follow-up of 99.2 months, 14 patients remained in the study.
    • Seven patients (50%) experienced spontaneous remission and discontinued treatment.
    • Of the seven symptomatic patients, diarrhoea was controlled with cholestyramine or anti-diarrhoeal agents; 75SeHCAT scans indicated persistent malabsorption.
    • Three asymptomatic patients showed improved 75SeHCAT retention, suggesting resolution.

    Conclusions:

    • Idiopathic bile acid malabsorption is a rare cause of diarrhoea, necessitating thorough investigation to rule out other serious gastrointestinal conditions.
    • Long-term follow-up is recommended as some patients may develop other gastrointestinal diseases.
    • Approximately 50% of patients with IBAM may achieve spontaneous remission, potentially eliminating the need for ongoing medication.