Impact of bile acid malabsorption on steatorrhoea and symptoms in patients with chronic diarrhoea

OBJECTIVE DESIGN METHODS RESULTSForty-two patients had a SeHCAT value < 10%. Mild steatorrhoea was common in patients with nonorganic bile acid malabsorption (50%) and in patients with functional diarrhoea (38%). There was no correlation between low SeHCAT values and steatorrhoea, although some patients with severe organic disease had a concomitant malabsorption of fat and of bile acids. In coeliac disease, severe steatorrhoea was common even in patients with high SeHCAT values. Patients with bile acid malabsorption had more frequent (P < 0.008) and looser (P = 0.0021) stools compared with patients with functional diarrhoea. There was no difference in abdominal pain, distension or flatulence. CONCLUSIONMild steatorrhoea is common in both nonorganic bile acid malabsorption and functional diarrhoea. The SeHCAT value cannot predict the risk of steatorrhoea. The high prevalence of bile acid malabsorption in patients with chronic diarrhoea and the absence of specific symptoms, except frequent and more liquid stools, indicates that the SeHCAT test should be performed early in the investigation of these patients. Eur J Gastroenterol Hepatol 12:541-547