{
  "abstract": "Bile acid diarrhoea (BAD) is characterised by increased bile acid loss and chronic lower gastrointestinal symptoms including cramping pain and diarrhoea. It is more commonly seen in the setting of ileal resection or disease but has overlapping features with conditions such as diarrhoea-prominent IBS (IBS-D) and may be underdiagnosed, with around 20% of adolescents with IBS-D thought to have BAD. 1 Consideration of BAD is recommended in the management of IBS-D and testing for BAD is recommended in chronic diarrhoea.2BAD can be diagnosed using 75-selenium homotaurocholic acid test (SeHCAT) testing, but this involves a waiting list for the test, ionising radiation and several repeat nuclear medicine appointments. Studies have validated serum 7-alpha-hydroxy-4-cholesten-3-one (C4) as an alternative (increased serum C4 levels seen due to a compensatory increase in hepatic CYP7A1 activity).3 This should be sent on a fasted sample but can use a combined biochemistry sample therefore does not require additional blood sampling. C4 may be falsely increased in liver dysfunction and with bile acid sequestrant use.We aimed to evaluate utility of C4 in patients undergoing investigation for diarrhoea in a single tertiary centre. C4 testing was introduced on a trial basis.C4 results were prospectively collected and data was collected on reason for request (IBS-D, known short bowel syndrome (SBS) or other), test result, liver function tests (LFTs), subsequent SeHCAT request and result, treatment initiated and outcome.73 patients had C4 levels requested, 31/73 (42%) due to loose stool (probable IBS-D), 13/73 (18%) known short bowel syndrome), 29/73 (40%) other symptoms including constipation, abdominal pain. C4 results were grouped as < 50 (low/BAD unlikely), 50 – 142 (equivocal) and > 142 (high/BAD highly likely). 20/73 (27%) had equivocal or high C4 results. All with equivocal or high C4 had SeHCAT requested. To date 4 have had SeHCAT testing with 3 positive results (2 IBS-D, 1 SBS) and 1 negative (SBS). All patients with positive results started treatment with cholestyramine and have shown clinical improvement.6 patients had deranged LFTs but no association was shown between this and C4 level (2 low, 3 equivocal, 1 high).C4 is an easy and convenient screening test for BAD which can be used in combination with routine blood testing. Results largely correlated with SeHCAT results and therefore C4 could be used to guide trial of initiation of cholestyramine treatment without the need for SeHCAT testing. Results should be interpreted with caution in those with deranged LFTs although no association was seen in this study. Longer term follow up of this patient group is ongoing and larger studies are recommended to further evaluate the role of C4 testing.References Camilleri M, Nurko S. Bile Acid Diarrhea in Adults and Adolescents. Neurogastroenterol Motil. 2022 Apr; Epub 2021 Nov.Vasant DH, Paine PA, Black CJ. British society of gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021 Epub 2021.Gothe F, Beigel F, Rust C. Bile acid malabsorption assessed by 7 alpha-hydroxy-4-cholesten-3-one in pediatric inflammatory bowel disease: correlation to clinical and laboratory findings. J Crohns Colitis. 2014 Sep.",
  "authors": [
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Maria Hall"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Timothy Morris"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Virginia Chatzidaki"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Chai Lee"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Adnaan Kala"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Loveday Jago"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Andrew Fagbemi"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Maureen Lawson"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Sian Copley"
    }
  ],
  "title": "OC94 Using serum 7-alpha-hydroxy-4-cholesten-3-one (C4) levels to assist in screening and diagnosis of bile acid diarrhoea",
  "uid": "0607eaef-24ea-5af0-a0f1-f1d2a87223e1"
}