PWE-105 Is there a correlation between severity of bile acid malabsorption (BAM) and response to treatment?

Wilson Siu, I Ko, F McKiddle, Fiona Clegg, Gillian Bain, Alastair W McKinlay

Research output: Contribution to journalAbstract

Abstract

Introduction NICE guidelines in 2012 have recommended SeHCAT to be used in research in order to collect more information in its usefulness in the diagnosis and treatment of BAM. A previous study has identified a lack of consistent cut-off threshold values for abnormal SeHCAT results. The aim of this study is to determine whether there is any relationship between the severity of BAM and treatment response.
Methods Medical records of 492 patients who had a SeHCAT scan at Aberdeen Royal Infirmary between 23/7/2013 to 9/6/2017 were retrospectively reviewed. Mild, moderate and severe BAM were defined as 10.1%–15%, 5.1%–10% and <5% retention of SeHCAT after one week respectively. Data including the severity and types of BAM were recorded. Treatment responses to bile acid binders were also recorded when patients were followed up in the clinic after the scans.
Results 492 scans were performed and 51% (252/492) of patients had abnormal SeHCAT results (<15%) over the study period. The mean age was 51.6 with a female predominance of 69% (174/252).20% (50/252) of these patients had a prior diagnosis of IBS and 27% (67/252) patients had previous cholecystectomy.17% (44/252) had type 1 BAM, 53% (134/252) had type 2 BAM and 29% (74/252) had type 3 BAM. The mean SeHCAT retention percentage was 2.59% for type 1 BAM, 7.45% for type 2 BAM and 5.63% for type 3 BAM. The difference was statistically significant (p<0.001).52% (132/252) of patients had treatment response documented following their scans and 13% (17/132) of these patients stopped treatment due to side effects.For the remaining 115 patients, 71% (12/17) of patients with mild BAM had good response to bile acid binder compared to 77% (23/30) with moderate BAM and 78% (55/68) with severe BAM. The difference was not statistically significant (p<0.635).15 out of 90 patients who responded to colesevelam previously found cholestyramine ineffective or intolerance of it.
Conclusions In our study, the mean SeHCAT retention level was significantly lower for BAM type 1 compared to BAM types 2 and 3. There was an overall good therapeutic response to bile acid binders in patients with a positive SeHCAT scan. However, there was no statistically significant difference between severity of BAM and theurapeutic response.Further prospective study using larger sample size is required to assess the accuracy and cut-offs of the SeHCAT test in diagnosing BAM as determined by theurapeutic response to BAS treatment.
Original languageEnglish
Pages (from-to)A170
Number of pages1
JournalGut
Volume67
Issue numberSuppl. 1
DOIs
Publication statusPublished - 2018
EventBritish Society of Gastroenterology (BSG) Annual Meeting 2018 - ACC, Liverpool, United Kingdom
Duration: 4 Jun 20187 Jun 2018
https://www.bsg.org.uk/events/bsg-annual-meeting-2018.html

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Bile Acids and Salts
Therapeutics
Cholestyramine Resin
23-seleno-25-homotaurocholic acid

Keywords

  • Bile acid malabsorption
  • SeHCAT Scan
  • Treatment response
  • Bile acid binders

Cite this

PWE-105 Is there a correlation between severity of bile acid malabsorption (BAM) and response to treatment? / Siu, Wilson; Ko, I; McKiddle, F; Clegg, Fiona; Bain, Gillian; McKinlay, Alastair W.

In: Gut, Vol. 67, No. Suppl. 1, 2018, p. A170.

Research output: Contribution to journalAbstract

Siu, Wilson ; Ko, I ; McKiddle, F ; Clegg, Fiona ; Bain, Gillian ; McKinlay, Alastair W. / PWE-105 Is there a correlation between severity of bile acid malabsorption (BAM) and response to treatment?. In: Gut. 2018 ; Vol. 67, No. Suppl. 1. pp. A170.
@article{5210ec1386f44363b2faa3e57f79ab1e,
title = "PWE-105 Is there a correlation between severity of bile acid malabsorption (BAM) and response to treatment?",
abstract = "Introduction NICE guidelines in 2012 have recommended SeHCAT to be used in research in order to collect more information in its usefulness in the diagnosis and treatment of BAM. A previous study has identified a lack of consistent cut-off threshold values for abnormal SeHCAT results. The aim of this study is to determine whether there is any relationship between the severity of BAM and treatment response.Methods Medical records of 492 patients who had a SeHCAT scan at Aberdeen Royal Infirmary between 23/7/2013 to 9/6/2017 were retrospectively reviewed. Mild, moderate and severe BAM were defined as 10.1{\%}–15{\%}, 5.1{\%}–10{\%} and <5{\%} retention of SeHCAT after one week respectively. Data including the severity and types of BAM were recorded. Treatment responses to bile acid binders were also recorded when patients were followed up in the clinic after the scans.Results 492 scans were performed and 51{\%} (252/492) of patients had abnormal SeHCAT results (<15{\%}) over the study period. The mean age was 51.6 with a female predominance of 69{\%} (174/252).20{\%} (50/252) of these patients had a prior diagnosis of IBS and 27{\%} (67/252) patients had previous cholecystectomy.17{\%} (44/252) had type 1 BAM, 53{\%} (134/252) had type 2 BAM and 29{\%} (74/252) had type 3 BAM. The mean SeHCAT retention percentage was 2.59{\%} for type 1 BAM, 7.45{\%} for type 2 BAM and 5.63{\%} for type 3 BAM. The difference was statistically significant (p<0.001).52{\%} (132/252) of patients had treatment response documented following their scans and 13{\%} (17/132) of these patients stopped treatment due to side effects.For the remaining 115 patients, 71{\%} (12/17) of patients with mild BAM had good response to bile acid binder compared to 77{\%} (23/30) with moderate BAM and 78{\%} (55/68) with severe BAM. The difference was not statistically significant (p<0.635).15 out of 90 patients who responded to colesevelam previously found cholestyramine ineffective or intolerance of it.Conclusions In our study, the mean SeHCAT retention level was significantly lower for BAM type 1 compared to BAM types 2 and 3. There was an overall good therapeutic response to bile acid binders in patients with a positive SeHCAT scan. However, there was no statistically significant difference between severity of BAM and theurapeutic response.Further prospective study using larger sample size is required to assess the accuracy and cut-offs of the SeHCAT test in diagnosing BAM as determined by theurapeutic response to BAS treatment.",
keywords = "Bile acid malabsorption, SeHCAT Scan, Treatment response, Bile acid binders",
author = "Wilson Siu and I Ko and F McKiddle and Fiona Clegg and Gillian Bain and McKinlay, {Alastair W}",
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pages = "A170",
journal = "Gut",
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TY - JOUR

T1 - PWE-105 Is there a correlation between severity of bile acid malabsorption (BAM) and response to treatment?

AU - Siu, Wilson

AU - Ko, I

AU - McKiddle, F

AU - Clegg, Fiona

AU - Bain, Gillian

AU - McKinlay, Alastair W

PY - 2018

Y1 - 2018

N2 - Introduction NICE guidelines in 2012 have recommended SeHCAT to be used in research in order to collect more information in its usefulness in the diagnosis and treatment of BAM. A previous study has identified a lack of consistent cut-off threshold values for abnormal SeHCAT results. The aim of this study is to determine whether there is any relationship between the severity of BAM and treatment response.Methods Medical records of 492 patients who had a SeHCAT scan at Aberdeen Royal Infirmary between 23/7/2013 to 9/6/2017 were retrospectively reviewed. Mild, moderate and severe BAM were defined as 10.1%–15%, 5.1%–10% and <5% retention of SeHCAT after one week respectively. Data including the severity and types of BAM were recorded. Treatment responses to bile acid binders were also recorded when patients were followed up in the clinic after the scans.Results 492 scans were performed and 51% (252/492) of patients had abnormal SeHCAT results (<15%) over the study period. The mean age was 51.6 with a female predominance of 69% (174/252).20% (50/252) of these patients had a prior diagnosis of IBS and 27% (67/252) patients had previous cholecystectomy.17% (44/252) had type 1 BAM, 53% (134/252) had type 2 BAM and 29% (74/252) had type 3 BAM. The mean SeHCAT retention percentage was 2.59% for type 1 BAM, 7.45% for type 2 BAM and 5.63% for type 3 BAM. The difference was statistically significant (p<0.001).52% (132/252) of patients had treatment response documented following their scans and 13% (17/132) of these patients stopped treatment due to side effects.For the remaining 115 patients, 71% (12/17) of patients with mild BAM had good response to bile acid binder compared to 77% (23/30) with moderate BAM and 78% (55/68) with severe BAM. The difference was not statistically significant (p<0.635).15 out of 90 patients who responded to colesevelam previously found cholestyramine ineffective or intolerance of it.Conclusions In our study, the mean SeHCAT retention level was significantly lower for BAM type 1 compared to BAM types 2 and 3. There was an overall good therapeutic response to bile acid binders in patients with a positive SeHCAT scan. However, there was no statistically significant difference between severity of BAM and theurapeutic response.Further prospective study using larger sample size is required to assess the accuracy and cut-offs of the SeHCAT test in diagnosing BAM as determined by theurapeutic response to BAS treatment.

AB - Introduction NICE guidelines in 2012 have recommended SeHCAT to be used in research in order to collect more information in its usefulness in the diagnosis and treatment of BAM. A previous study has identified a lack of consistent cut-off threshold values for abnormal SeHCAT results. The aim of this study is to determine whether there is any relationship between the severity of BAM and treatment response.Methods Medical records of 492 patients who had a SeHCAT scan at Aberdeen Royal Infirmary between 23/7/2013 to 9/6/2017 were retrospectively reviewed. Mild, moderate and severe BAM were defined as 10.1%–15%, 5.1%–10% and <5% retention of SeHCAT after one week respectively. Data including the severity and types of BAM were recorded. Treatment responses to bile acid binders were also recorded when patients were followed up in the clinic after the scans.Results 492 scans were performed and 51% (252/492) of patients had abnormal SeHCAT results (<15%) over the study period. The mean age was 51.6 with a female predominance of 69% (174/252).20% (50/252) of these patients had a prior diagnosis of IBS and 27% (67/252) patients had previous cholecystectomy.17% (44/252) had type 1 BAM, 53% (134/252) had type 2 BAM and 29% (74/252) had type 3 BAM. The mean SeHCAT retention percentage was 2.59% for type 1 BAM, 7.45% for type 2 BAM and 5.63% for type 3 BAM. The difference was statistically significant (p<0.001).52% (132/252) of patients had treatment response documented following their scans and 13% (17/132) of these patients stopped treatment due to side effects.For the remaining 115 patients, 71% (12/17) of patients with mild BAM had good response to bile acid binder compared to 77% (23/30) with moderate BAM and 78% (55/68) with severe BAM. The difference was not statistically significant (p<0.635).15 out of 90 patients who responded to colesevelam previously found cholestyramine ineffective or intolerance of it.Conclusions In our study, the mean SeHCAT retention level was significantly lower for BAM type 1 compared to BAM types 2 and 3. There was an overall good therapeutic response to bile acid binders in patients with a positive SeHCAT scan. However, there was no statistically significant difference between severity of BAM and theurapeutic response.Further prospective study using larger sample size is required to assess the accuracy and cut-offs of the SeHCAT test in diagnosing BAM as determined by theurapeutic response to BAS treatment.

KW - Bile acid malabsorption

KW - SeHCAT Scan

KW - Treatment response

KW - Bile acid binders

U2 - 10.1136/gutjnl-2018-BSGAbstracts.339

DO - 10.1136/gutjnl-2018-BSGAbstracts.339

M3 - Abstract

VL - 67

SP - A170

JO - Gut

JF - Gut

SN - 0017-5749

IS - Suppl. 1

ER -