P260 Bile Acid Diarrhoea outside tertiary centres-how bad is BAD?
| Autor: | Katja Christodoulou, Danielle L Morris, Dhanoop Mohandas |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
education.field_of_study Referral business.industry medicine.medical_treatment Population medicine.disease Faecal calprotectin Coeliac disease chemistry.chemical_compound chemistry Internal medicine medicine Cholecystectomy Risk factor Thyroid function SeHCAT education business |
| Zdroj: | Posters. |
| DOI: | 10.1136/gutjnl-2020-bsgcampus.334 |
| Popis: | Introduction Chronic diarrhoea causes significant morbidity and these patients are commonly referred to gastroenterology clinic. Bile acid diarrhoea (BAD) is considered causal in up to 1/3 of people investigated for IBS-D. BSG guidelines recommend investigation for BAD in secondary care using SeHCAT scanning/serum bile acid precursors.1 Empirical trial of treatment is not recommended. Access to tests can be limited in district general hospital settings. We report our experience in a DGH where diagnostic testing is provided by a centre 39 miles away. Methods A retrospective notes review was performed for all outpatients from East and North Herts NHS trust (catchment population 600,000) who had SeHCAT scans performed by a regional service (Mount Vernon Hospital) in 2019. Data were collected on demographics, symptoms, risk factors, other investigations, time between first clinic and scanning and prior empirical treatment. Comparison were made between positive and negative groups using multiple regression analysis. Results 50 scans were requested of which 48 results were available. Median age was 49 (23 – 84 y), 33(69%) female. 21 scans (44%) were positive for BAD, 3 (14%) mild, 10 (48%) moderate 8 (38%) severe. Only patients with complete data (45) were included in subsequent analyses. Risk factors are presented in table 1. A statistically significant association between cholecystectomy and positive SeHCAT scan was found (P=0.026). There was considerable delay in diagnostic confirmation for some patients with a positive test taking 1 month to 10 years. Overall 41/45 patients had prior testing with faecal calprotectin (FC), 32 patients had colonoscopies of whom 24 had colonic biopsies, 43/50 had thyroid function checked and 39/50 were screened for coeliac disease. 10 patients had empirical treatment with bile acid sequestrants before scanning. Conclusions Our study has shown a burden of incident BAD in the outpatient DGH setting. This is underestimated due to use of empirical treatment without testing, lack of investigation of some patients with disease and referral for SeHCAT scanning in other centres not identified. Patients had appropriate initial investigations performed for chronic diarrhoea. In keeping with larger studies from tertiary centres prior cholecystectomy is the commonest predisposing factor (type III) and >1/3 of patients had no identified risk factor (type II). There are limited data regarding BAD investigation and management in DGH setting where patients have to travel considerable distance for testing. There are problems associated with empirical treatment including current drug availability in the UK. National management guidelines based on large studies and wider availability of economically viable testing are needed. Reference Arasaradnam RP, Brown S, Forbes A et al. Gut Epub ahead of print (13 April 2018) doi:10.1136/gutjnl-2017-315909 |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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