PWE-105 is There a Correlation Between Severity of Bile Acid Malabsorption (BAM) and Response to Treatment?

IntroductionNICE 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.MethodsMedical 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.Results492 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.ConclusionsIn 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.