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Outcomes from treating bile acid malabsorption using a multidisciplinary approach

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Abstract

Background & aim

Despite bile acid malabsorption affecting >1 % of the population, the outcomes of treatment are largely unreported. This study evaluated the effectiveness of a structured intervention for this condition.

Method

This was a retrospective evaluation of prospectively recorded patient reported outcome measures in a consecutive cohort of patients diagnosed with bile acid malabsorption seen in a cancer centre gastroenterology clinic. Every patient completed a 7-day food diary, a gastrointestinal symptom rating scale questionnaire and Bristol stool chart before the first clinic appointment and the symptom questionnaire and Bristol stool chart before all subsequent appointments. Patients who reported any episodes of type 6 or 7 stool were referred for a 75Selenium (Se) homocholic acid taurine scan. Abnormal gastrointestinal symptoms were investigated and treated systematically using a peer reviewed management algorithm.

Results

Between 2011 and 2013, 136 men, 146 women, median age 66 years (range 19–89) underwent a scan. 143 (51 %) had 7-day isotope retention of ≤20 %. 105 (73 %) had previously undergone pelvic radiotherapy and 67 (47 %) GI surgery. 123 (86 %) were treated with low-fat diets, 79 (55 %) with a bile acid sequestrant, 73 (51 %) both. On discharge, 100 (70 %) patients reported an overall symptom improvement (mean −4.2 points, p < 0.0001). In patients who had only bile acid malabsorption and no other gastrointestinal diagnoses, 77 % (41/53) reported a mean improvement of −5.4 points (p < 0.0005). Patients reported a clinically significant improvement in urgency, faecal incontinence, wind, nocturnal defaecation, tiredness, abdominal pain, bloating, and steatorrhoea, (p = <0.0005). Stool frequency was reduced and stool consistency was improved.

Conclusion

In this large cohort of complex patients, bile acid malabsorption is common and a multidisciplinary approach to managing gastrointestinal symptoms is effective.

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Acknowledgments

We acknowledge support from the National Institute for Health Research Royal Marsden Biomedical Research Centre. We thank Eva Grace for helpful advice with extraction of the data. There was no funding for this study.

Conflict of interest

HJNA has chaired advisory boards for GE, manufacturers of SeHCAT and for Sanofi Aventis and Genzyme, and manufacturers of Colesevelam and has received honoraria as a speaker and consultant for these companies.

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Authors and Affiliations

  1. The GI Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK

    Ankur Gupta, Ann C. Muls, Amyn Lalji & H. Jervoise N. Andreyev

  2. Department of Statistics, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK

    Karen Thomas

  3. Department of Nutrition and Dietetics, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK

    Lorraine Watson & Clare Shaw

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  1. Ankur Gupta
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  2. Ann C. Muls
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  7. H. Jervoise N. Andreyev
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Correspondence to H. Jervoise N. Andreyev.

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Gupta, A., Muls, A.C., Lalji, A. et al. Outcomes from treating bile acid malabsorption using a multidisciplinary approach. Support Care Cancer 23, 2881–2890 (2015). https://doi.org/10.1007/s00520-015-2653-5

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  • DOI: https://doi.org/10.1007/s00520-015-2653-5

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