Outcomes from treating bile acid malabsorption using a multidisciplinary approach

Gupta, Ankur; Muls, Ann C.; Lalji, Amyn; Thomas, Karen; Watson, Lorraine; Shaw, Clare; Andreyev, H. Jervoise N.

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.

Citation

Gupta, A., Muls, A. C., Lalji, A., Thomas, K., Watson, L., Shaw, C., & Andreyev, H. J. N. (2015). Outcomes from treating bile acid malabsorption using a multidisciplinary approach. Supportive Care in Cancer, 23(10), 2881-2890. https://doi.org/10.1007/s00520-015-2653-5

• Journal Article Type: Article
• Acceptance Date: Feb 8, 2015
• Online Publication Date: Feb 20, 2015
• Publication Date: 2015-10
• Deposit Date: Jan 16, 2024
• Journal: Supportive Care in Cancer
• Print ISSN: 0941-4355
• Electronic ISSN: 1433-7339
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 23
• Issue: 10
• Pages: 2881-2890
• DOI: https://doi.org/10.1007/s00520-015-2653-5
• Keywords: Oncology
• Public URL: https://keele-repository.worktribe.com/output/706829