Kurien Matthew, Evans Kate E, Leeds John S, Hopper Andy D, Harris Andrew, Sanders David S
Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
Scand J Gastroenterol. 2011 Jul;46(7-8):818-22. doi: 10.3109/00365521.2011.574728. Epub 2011 Apr 15.
Bile acid malabsorption (BAM) has been reported as a possible cause of diarrhea predominant irritable bowel syndrome (D-IBS) type symptoms. We aimed to determine how commonly patients with D-IBS type symptoms had a diagnosis of BAM as demonstrated by a positive SeHCAT (75 Selenium-homocholic acid taurine) test (retention <10% at seven days).
A retrospective analysis was undertaken of patient's records for all patients who underwent a SeHCAT test between 2001 and 2009 in a tertiary hospital (Group A). Concurrently, a cohort of patients with Rome II D-IBS type symptoms was examined to determine the potential utility of SeHCAT test (Group B).
In Group A 39.2% (n = 107/273) of patients had a positive SeHCAT result. The median time from first hospital visit to SeHCAT result was 30 weeks. Predictive factors for BAM: terminal ileal Crohn's disease (p < 0.01), terminal ileal resection (p < 0.01), and previous cholecystectomy (p < 0.01). 33.6% of patients who had a positive SeHCAT also had Rome II D-IBS. In Group B the D-IBS control cohort only 1.9% of patients had undergone a SeHCAT scan (p < 0.001 compared to Group A).
BAM is common and should be considered earlier when investigating unselected patients with D-IBS type symptoms.
胆汁酸吸收不良（BAM）已被报道为腹泻型肠易激综合征（D-IBS）症状的一个可能病因。我们旨在确定有D-IBS型症状的患者中，经75硒-同型胆酸牛磺酸（SeHCAT）试验阳性（7天滞留率<10%）证实为BAM的诊断有多常见。
对2001年至2009年在一家三级医院接受SeHCAT试验的所有患者的病历进行回顾性分析（A组）。同时，对一组有罗马II型D-IBS症状的患者进行检查，以确定SeHCAT试验的潜在效用（B组）。
在A组中，39.2%（n = 107/273）的患者SeHCAT结果为阳性。从首次就诊到获得SeHCAT结果的中位时间为30周。BAM的预测因素：终末回肠克罗恩病（p < 0.01）、终末回肠切除术（p < 0.01）和既往胆囊切除术（p < 0.01）。SeHCAT结果为阳性的患者中，33.6%也患有罗马II型D-IBS。在B组的D-IBS对照队列中，只有1.9%的患者接受了SeHCAT扫描（与A组相比，p < 0.001）。
BAM很常见，在对未选定的有D-IBS型症状的患者进行调查时应更早考虑。
