A single faecal bile acid stool test demonstrates potential efficacy in replacing SeHCAT testing for bile acid diarrhoea in selected patients

Aditi Kumar; Hafid O Al-Hassi; Manushri Jain; Oliver Phipps; Clare Ford; Rousseau Gama; Helen Steed; Jeffrey Butterworth; John McLaughlin; Niall Galbraith; Matthew J Brookes; Lauren E Hughes

doi:10.1038/s41598-022-12003-z

A single faecal bile acid stool test demonstrates potential efficacy in replacing SeHCAT testing for bile acid diarrhoea in selected patients

Sci Rep. 2022 May 18;12(1):8313. doi: 10.1038/s41598-022-12003-z.

Authors

Aditi Kumar^{1

2}, Hafid O Al-Hassi³, Manushri Jain⁴, Oliver Phipps³, Clare Ford⁵, Rousseau Gama^{5

6}, Helen Steed^{4

6}, Jeffrey Butterworth⁷, John McLaughlin^{8

9}, Niall Galbraith³, Matthew J Brookes^{4

6}, Lauren E Hughes⁵

Affiliations

¹ The Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP, UK. aditikumar@nhs.net.
² University of Wolverhampton, Wolverhampton, UK. aditikumar@nhs.net.
³ University of Wolverhampton, Wolverhampton, UK.
⁴ The Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP, UK.
⁵ Clinical Chemistry, Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
⁶ School of Medicine and Clinical Practice, Faculty of Sciences and Engineering, University of Wolverhampton, Wolverhampton, UK.
⁷ Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK.
⁸ Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
⁹ Department of Gastroenterology, Salford Royal Foundation Trust, Stott Lane, Salford, UK.

Abstract

This study examines the validity of measuring faecal bile acids (FBA) in a single stool sample as a diagnostic tool for bile acid diarrhoea (BAD) by direct comparison to the ⁷⁵selenium-homotaurocholic acid (SeHCAT) scan. A prospective observational study was undertaken. Patients with chronic diarrhoea (> 6 weeks) being investigated for potential BAD with SeHCAT scan provided stool samples for measurement of FBA, using an enzyme-linked immunosorbent assay. Patients were characterised into four groups: SeHCAT negative control group, post-cholecystectomy, idiopathic BAD and post-operative terminal ileal resected Crohn's disease. Stool samples were collected at baseline and 8-weeks post treatment to determine whether FBA measurement could be used to monitor therapeutic response. 113 patients had a stool sample to directly compare with their SeHCAT result. FBA concentrations (μmol/g) and interquartile ranges in patients in the control group (2.8; 1.6-4.2), BAD (3.6; 1.9-7.2) and post-cholecystectomy cohort 3.8 (2.3-6.8) were similar, but all were significantly lower (p < 0.001) compared to the Crohn's disease cohort (11.8; 10.1-16.2). FBA concentrations in patients with SeHCAT retention of < 15% (4.95; 2.6-10.5) and < 5% (9.9; 4.8-15.4) were significantly higher than those with a SeHCAT retention > 15% (2.6; 1.6-4.2); (p < 0.001 and p < 0.0001, respectively). The sensitivity and specificity using FBA cut-off of 1.6 μmol/g (using ≤ 15% SeHCAT retention as diagnostic of BAD) were 90% and 25% respectively. A single random stool sample may have potential use in diagnosing severe BAD or BAD in Crohn's patients. Larger studies are now needed to confirm the potential efficacy of this test to accurately diagnose BAD in the absence of SeHCAT testing.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Bile Acids and Salts / therapeutic use
Crohn Disease* / diagnosis
Diarrhea / diagnosis
Diarrhea / drug therapy
Humans
Ileal Diseases*
Selenium* / therapeutic use
Taurocholic Acid / analogs & derivatives

Substances

Bile Acids and Salts
Taurocholic Acid
23-seleno-25-homotaurocholic acid
Selenium