Baena García A, Partida Palma F, García Martínez S, de Bonilla Candau M, Pajares Vinardell M
Servicio de Medicina Nuclear, Hospital Universitario Puerta del Mar, Cádiz, España.
Servicio de Medicina Nuclear, Hospital Universitario Puerta del Mar, Cádiz, España.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2019 Sep-Oct;38(5):305-311. doi: 10.1016/j.remn.2018.12.005. Epub 2019 Feb 8.
Chronic diarrhoea due to bile acid malabsorption (BAM) is an underdiagnosed pathology. Different diagnostic tools are available. However, there is currently no consensus on which of these would be the benchmark test or gold standard. This review evaluates the possibility of using Se-taurocholic acid (SeHCAT) scintigraphy as a benchmark diagnostic test and its perspective for the future. A literature review was conducted in Pubmed and OVID obtaining a total of 57 papers, 26 of which were finally used after being selected under the concepts of gold standard, diagnostic accuracy and other biomarkers. We evaluated the advantages and disadvantages of the different diagnostic tools: C-glycocholate, measurement of bile acids in faeces, C4 in serum, FGF19 in serum, cholestyramine, and Se-tauroselcolic acid scintigraphy. We consider that the SeHCAT scan is the most recommended diagnostic test in Europe for diagnosing BAM as it presents the highest values of sensitivity and specificity. It has a significant cost-benefit ratio, making it the test with the highest degree of recommendation. However, it is still not possible to use it in a recognised way as a gold standard due to the lack of studies that provide conclusive data that allow consensus. In the meantime, the combined use of cholestyramine testing in all patients we want to evaluate, regardless of the scintigraphy result, could be encouraged as a benchmark standard.
胆汁酸吸收不良（BAM）所致慢性腹泻是一种诊断不足的病症。有多种诊断工具可供使用。然而，目前对于哪一种可作为基准测试或金标准尚无共识。本综述评估了使用硒-牛磺胆酸（SeHCAT）闪烁扫描作为基准诊断测试的可能性及其未来前景。在PubMed和OVID上进行了文献综述，共获得57篇论文，其中26篇最终根据金标准、诊断准确性和其他生物标志物的概念筛选后被采用。我们评估了不同诊断工具的优缺点：C-甘氨胆酸盐、粪便中胆汁酸的测量、血清中C4、血清中FGF19、考来烯胺以及硒-牛磺鹅去氧胆酸闪烁扫描。我们认为，SeHCAT扫描是欧洲诊断BAM最推荐的诊断测试，因为它具有最高的敏感性和特异性值。它具有显著的成本效益比，使其成为推荐程度最高的测试。然而，由于缺乏提供确凿数据以达成共识的研究，目前仍无法将其作为公认的金标准使用。同时，无论闪烁扫描结果如何，对于所有我们想要评估的患者，鼓励联合使用考来烯胺测试作为基准标准。
