IDIOPATHIC BILE-ACID MALABSORPTION - A REVIEW OF CLINICAL PRESENTATION, DIAGNOSIS, AND RESPONSE TO TREATMENT

Between 1982 and 1989, the seven day retention of Se-75-HCAT was measured in 181 patients with chronic diarrhoea that remained unexplained after full investigation. Altogether 121 of the 181 had a seven day Se-75-HCAT retention greater-than-or-equal-to 15% and thus had no evidence of abnormal bile acid turnover. Twenty one had a seven day Se-75-HCAT retention greater-than-or-equal-to 10% but < 15%. Their clinical features were typical of the irritable bowel syndrome, and none of eight treated with cholestyramine showed symptomatic improvement. Sixteen patients had a seven day retention greater-than-or-equal-to 5% and < 10%, six of whom had improved symptoms after treatment with bile acid chelating agents. The remaining 23 patients had a Se-75-HCAT retention of < 5% at seven days and responded to bile acid chelators. This group had a characteristic illness with intermittent watery diarrhoea, but no constitutional upset. It was not possible to distinguish the patients with bile acid mal-absorption exclusively on the basis of the clinical symptoms and investigations, other than Se-75-HCAT retention. We conclude that the measurement of Se-75-HCAT retention is useful, appropriate, and necessary in patients with unexplained chronic diarrhoea.