Wildt S, Nørby Rasmussen S, Lysgård Madsen J, Rumessen J J
Dept. of Medical Gastroenterology, Hvidovre Hospital, University Hospital of Copenhagen, Denmark.
Scand J Gastroenterol. 2003 Aug;38(8):826-30. doi: 10.1080/00365520310004461.
Bile acid malabsorption (BAM), a cause of chronic diarrhoea, can be diagnosed by the SeHCAT test. The purpose of this study was to evaluate the usefulness of SeHCAT testing by assessing the extent of BAM and describing the clinical characteristics in a group of patients with chronic diarrhoea. Clinical outcome after treatment with cholestyramine was also evaluated.
During a 5-year period (1997-2001) the SeHCAT test was performed in 135 patients in whom a primary programme for diagnostic evaluation of chronic diarrhoea had not revealed a cause. File data from 133 patients could be evaluated.
In 44% of patients, bile acid absorption was normal with SeHCAT retention > or = 15%. Impaired SeHCAT retention was found in 56%. All patients with ileocaecal resections had retention values < 10%. Patients with microscopic colitis presented with BAM in 39%. Only one patient with idiopathic BAM presented with steatorrhoea as opposed to 11 patients with type 1 and 3 BAM. Patients with idiopathic BAM and/or SeHCAT retention values < 5% had the best response to treatment with cholestyramine.
The SeHCAT test is of value in evaluation of patients with chronic diarrhoea as a second-line investigation with a high diagnostic yield. The only a priori parameter to predict BAM was the existence of ileocaecal resections. The result of the SeHCAT test seems to predict the benefit of treatment with cholestyramine.
胆汁酸吸收不良（BAM）是慢性腹泻的一个病因，可通过硒-同型半胱氨酸-甲基转移酶（SeHCAT）试验进行诊断。本研究的目的是通过评估BAM的程度并描述一组慢性腹泻患者的临床特征，来评价SeHCAT试验的实用性。还评估了考来烯胺治疗后的临床结果。
在5年期间（1997 - 2001年），对135例慢性腹泻初步诊断评估未发现病因的患者进行了SeHCAT试验。133例患者的档案数据可进行评估。
44%的患者胆汁酸吸收正常，SeHCAT潴留率≥15%。56%的患者SeHCAT潴留受损。所有回盲部切除的患者潴留值<10%。显微镜下结肠炎患者中39%存在BAM。只有1例特发性BAM患者出现脂肪泻，而1型和3型BAM患者中有11例出现脂肪泻。特发性BAM和/或SeHCAT潴留值<5%的患者对考来烯胺治疗反应最佳。
SeHCAT试验作为二线检查手段，在慢性腹泻患者评估中具有重要价值，诊断率高。预测BAM的唯一先验参数是回盲部切除的存在。SeHCAT试验结果似乎可预测考来烯胺治疗的获益情况。
