{
  "abstract": "Introduction Bile acid diarrhoea (BAD) is caused by colonic irritation from excess bile acid entering the colon due to reduced jejunal absorption or increased production. As per the British Society of Gastroenterology guidelines, tauroselcholic [75 selenium] acid (SeHCAT) scans are the gold standard for diagnosing BAD however, given limited evidence, NICE is unable to recommend its routine adoption at present. Bile acid sequestrants (BAS) are used to treat BAD and current treatment options available are cholestyramine (licensed) or colesevelam (unlicensed). We present our findings on how SeHCAT scan results affect decisions regarding treatment, as well as tolerability of BAS.Methods A retrospective observational study was conducted of adult patients undergoing SeHCAT scanning for investigation of chronic diarrhoea at a single NHS Trust over a defined period from 2018 to 2022. Electronic and paper records were reviewed to assess prior investigations for chronic diarrhoea, including faecal calprotectin, faecal elastase, coeliac serology, and lower gastrointestinal endoscopy. SeHCAT scan results were recorded, with bile acid diarrhoea defined as <10% seven-day retention. Subsequent management was evaluated, including prescription and treatment uptake of bile acid sequestrants (cholestyramine or colesevelam) and change of treatment due to intolerance. Data was analysed and compared with published UK data where appropriate.Results 169 patients who received a SeHCAT scan within the trust were included, including those referred from other trusts. 34 (20%) did not have a calprotectin or elastase prior to scan. Only 41 (24%) were tested for both. Out of 161 patients who had SeHCAT scans, 25 (16%) did not undergo any endoscopic investigation. Out of 136 patients with a positive result (<10% retention), only 69 (74%) received BAS treatment, similar to BMJ data from 2016 (73%). Out of 93 patients treated with cholestyramine, 21 (23%) were switched to colesevelam.Conclusions SeHCAT testing is a useful investigation in patients with chronic diarrhoea and often aids in diagnosis. However, other investigations which are more cost-effective (calprotectin, elastase, coeliac screen, endoscopy) tend to be underutilised; investigation of chronic diarrhoea appears to have substantial variation in adherence to baseline investigations based on guidelines. A significant proportion of patients with positive SeHCAT results did not receive BAS therapy, indicating potential under-treatment of BAD. Colesevelam is better tolerated compared to cholestyramine as reflected by treatment switching. These findings highlight the need for more defined diagnostic pathways for chronic diarrhoea and prospective comparative studies evaluating tolerability and effectiveness of bile acid sequestrants to establish treatment guidelines.",
  "authors": [
    {
      "affiliations": [
        "County Durham and Darlington NHS Foundation Trust, Darlington, United Kingdom"
      ],
      "name": "Ramdeep Romann"
    },
    {
      "affiliations": [
        "County Durham and Darlington NHS Foundation Trust, Darlington, United Kingdom"
      ],
      "name": "Ramdeep Romann"
    },
    {
      "affiliations": [
        "County Durham and Darlington NHS Foundation Trust, Darlington, United Kingdom"
      ],
      "name": "Tina Hinchliffe"
    },
    {
      "affiliations": [
        "County Durham and Darlington NHS Foundation Trust, Darlington, United Kingdom"
      ],
      "name": "Helen Dallal"
    }
  ],
  "title": "P302 Real-world use of SeHCAT scanning and bile acid sequestrants in chronic diarrhoea: a retrospective NHS study",
  "uid": "e95dc34e-4cab-5488-9d4c-39149e356a98"
}