A Century of SeHCATs: Utilisation and outcomes of the selenium homotaurocholic acid test (SeHCAT) in Belfast.

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Introduction

Bile acid malabsorption (BAM) accounts for over 25% of patients with diarrhoea predominant irritable bowel symptoms. In addition, interruption of enterohepatic recirculation of bile acids in the terminal ileum (TI) may cause diarrhoeal symptoms in patients with surgical resections, Crohn’s disease, radiation damage or ischaemia. The SeHCAT scan objectively measures bile acid retention allowing identification of BAM.

Aims

Evaluate SeHCAT use in Northern Ireland.

Methods

Retrospective identification of patients from a hospital radiology database correlated with clinical records.

Results

One hundred patients attended for a SeHCAT between June 2010 and August 2014. Tests performed have risen from 4 in 2010, to 51 in the first eight months of 2014. Testing was performed in all cases for diarrhoeal symptoms: Idiopathic diarrhoea (40%), post cholecystectomy (15%), Crohn’s with ileal resection (29%), other ileal resection (8%), previous abdominopelvic radiation therapy (4%) and Crohn’s disease without resection (4%).

We found positive tests for BAM in 40% (16/40) patients with idiopathic diarrhoea, 60% (9/15) patients with postcholecystectomy diarrhoea and 97% (28/29) patients with Crohn’s disease and ileal resection. All 28 of these Crohn’s resections had severe BAM (<5% retention at one week).

Conclusion

SeHCAT scan utilisation is rising and the positive yield is high. The likelihood of a negative SeHCAT test in patients with Crohn’s and ileal resection appears very low. Larger studies are required but our results suggest some patient groups could benefit from empirical trial of therapy rather than SeHCAT scanning.

References

Vijayvargiya P et al. Methods for diagnosis of bile acid malabsorption in clinical practice. Clin Gastroenterol Hepatol. 2013 Oct;11(10):1232-9