Luman W, Williams A J, Merrick M V, Eastwood M A
Department of Gastroenterology and Nuclear Medicine, Western General Hospital, Edinburgh, UK.
Eur J Gastroenterol Hepatol. 1995 Jul;7(7):641-5.
Idiopathic bile acid malabsorption (IBAM) is a rare cause of diarrhoea. The natural history of this disorder has not previously been reported. The aim of our study was to determine the long-term outcome in a cohort of patients with severe IBAM using a subjective assessment and by measuring the proportion of 75Se-homocholic acid taurine (75SeHCAT) retained 7 days after its ingestion.
Twenty-three patients with IBAM were identified in 1989. All had responded well to treatment with a bile acid chelator (cholestyramine or aluminium hydroxide). Questionnaires relating to current clinical symptoms and prescriptions were sent to these patients and their general practitioners. 75SeHCAT tests were performed for objective assessment.
Three patients were lost to follow-up, three had died owing to malignancy and three had been diagnosed as suffering from inflammatory bowel disease. The mean period of follow-up for the remaining fourteen patients was 99.2 (range 48-140) months. Seven of the patients showed an improvement in symptoms and no longer required treatment with cholestyramine. In the remaining seven symptomatic patients, diarrhoea was well controlled by continued treatment with cholestyramine (five patients) or standard anti-diarrhoeal treatment (two patients). All seven symptomatic patients and three asymptomatic patients underwent repeat 7 day 75SeHCAT tests. The test results in the asymptomatic group had all improved so that the retention of the tracer after 7 days was above 5%; all but two patients in the symptomatic group still had values under 5%. However, the small number of patients in both groups precluded statistical analysis.
IBAM is a rare cause of diarrhoea and should be diagnosed only after malignancy and inflammatory bowel disease have been excluded by rigorous investigations. Patients should be followed up as some develop other serious gastrointestinal diseases. Fifty per cent of the patients in our survey have remitted spontaneously and no longer require medication with bile acid chelators or anti-diarrhoeal agents.
特发性胆汁酸吸收不良（IBAM）是腹泻的罕见病因。此前尚未报道过这种疾病的自然病史。我们研究的目的是通过主观评估以及测量摄入75硒-高胆酸牛磺酸（75SeHCAT）7天后的潴留比例，来确定一组重症IBAM患者的长期预后。
1989年确诊了23例IBAM患者。所有患者对胆汁酸螯合剂（考来烯胺或氢氧化铝）治疗反应良好。向这些患者及其全科医生发送了有关当前临床症状和处方的问卷。进行75SeHCAT试验以进行客观评估。
3例患者失访，3例因恶性肿瘤死亡，3例被诊断为患有炎症性肠病。其余14例患者的平均随访时间为99.2（范围48 - 140）个月。7例患者症状改善，不再需要考来烯胺治疗。在其余7例有症状的患者中，腹泻通过继续使用考来烯胺治疗（5例患者）或标准止泻治疗（2例患者）得到良好控制。所有7例有症状的患者和3例无症状的患者均接受了重复的7天75SeHCAT试验。无症状组的试验结果均有所改善，以至于7天后示踪剂的潴留率高于5%；有症状组除2例患者外，其余患者的值仍低于5%。然而，两组患者数量较少，无法进行统计学分析。
IBAM是腹泻的罕见病因，只有在通过严格检查排除恶性肿瘤和炎症性肠病后才能确诊。应随访患者，因为一些患者会发展为其他严重的胃肠道疾病。我们调查中的患者有50%已自发缓解，不再需要使用胆汁酸螯合剂或止泻药。
