Real-world experience with the diagnosis of bile acid malabsorption (BAM) using serum 7-alpha-C4 and 48-hour stool bile acids
Introduction and aims: Bile acid malabsorption (BAM) is responsible for 30% of cases of diarrhea-predominant irritable bowel syndrome (IBS-D) or functional diarrhea and 63.5% of cases of diarrhea following cholecystectomy. 75SeHCAT is the gold standard diagnostic method but is unavailable in Mexico....
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-04-01
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| Series: | Revista de Gastroenterología de México (English Edition) |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2255534X25000398 |
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| Summary: | Introduction and aims: Bile acid malabsorption (BAM) is responsible for 30% of cases of diarrhea-predominant irritable bowel syndrome (IBS-D) or functional diarrhea and 63.5% of cases of diarrhea following cholecystectomy. 75SeHCAT is the gold standard diagnostic method but is unavailable in Mexico. Alternatively, primary bile acid (PBA) and total bile acid (TBA) determination in 48 h stools and 7αC4 measurement have been proposed as screening tests. Objective: Our aim was to evaluate the experience with PBAs and/or TBAs and to determine whether 7αC4 is a good screening biomarker for BAM in clinical practice. Material and methods: An ambispective study of patients with chronic diarrhea was conducted. BAM was considered present with 7αC4 > 55 ng/mL (cost $420.00 USD), PBAs ≥ 9.8%, TBAs > 2,337 μmol/48 h, or TBAs > 1,000 μmol/48 h + PBAs > 4% (TBAs + PBAs) ($405.00 USD). However, those tests must be shipped to the US for their analysis (total cost $825.00 USD). Data were compared using the chi-square test and Student’s t test, and Spearman’s Rho correlations were calculated. Results: We analyzed 48 patients with 7αC4 (age: 58.4 ± 16.9, women: 54.2%). BAM was confirmed by 7αC4 in 12.5%, by PBAs in 38.9%; by TBAs in 5.5%, and by TBAs + PBAs in 16.7%. We found elevated 7αC4 in patients with high or normal PBA/TBA levels (correlation with TBAs: 0.542, p = 0.020; PBAs: -0.127, p = 0.605; TBAs + PBAs: -0.200, p = 0.426). Lastly, BAM identified by 7αC4 was more frequent in patients with previous cholecystectomy (22.7%) vs. those without (3.8%). Conclusions: Our study confirms that 7αC4 correlates well with TBAs and is a good biomarker for BAM screening because it can be elevated, despite normal PBA/TBA levels. Additionally, it represents a 49% cost savings in BAM investigation. Resumen: Introducción: La malabsorción de ácidos biliares (MAAB) causa el 30% de los casos de síndrome de intestino irritable con diarrea (IBS-D) o diarrea funcional, y 63.5% de diarrea por colecistectomía. La prueba diagnóstica de referencia es 75SeHCAT, no disponible localmente. Alternativamente se ha propuesto la determinación de ácidos biliares primarios (ABP) y totales (ABT) en heces de 48 horas, y 7αC4 sérico como tamizaje. Objetivo: Evaluar la experiencia con ABP y/o ABT, y determinar si 7αC4 es un buen biomarcador para MAAB en la clínica. Materiales y métodos: Estudio ambispectivo de pacientes con diarrea crónica. Se consideró MAAB con 7αC4 > 55 ng/mL (costo $420.00 US); ABP ≥ 9.8%; ABT>2337 μmol/48 hrs; o ABT>1000 μmol/48 hrs + ABP > 4% (ABT + ABP) ($405.00 US). Sin embargo, estas deben ser enviada a USA para su análisis (total $825.00 US). Los datos se compararon mediante X2, t-Student, y correlaciones mediante Rho de Spearman. Resultados: Se analizaron 48 pacientes estudiados con 7αC4 (edad: 58.4 ± 16.9, mujeres: 54.2%). Se confirmó MAAB en 12.5% MAAB por 7αC4, 38.9% por ABP, 5.5% por ABT, y 16.7% con ABP + ABT. Se encontró 7αC4 elevado tanto en aquellos con ABP y/o ABT elevados o normales (correlación con ABT: 0.542, p = 0.020; ABP: -0.127, p = 0.605; ABT + ABP: -0.200; p = 0.426). Finalmente, la MAAB por 7αC4 fue más frecuente en pacientes con (22.7%) vs. sin (3.8%) colecistectomía previa. Conclusiones: Este estudio confirma que 7αC4 se correlaciona adecuadamente con ABT y es un buen biomarcador para tamizaje de MAAB, ya que puede estar elevado a pesar de ABP/ABT normales. Además, representa un ahorro del 49% en el costo del estudio de MAAB. |
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| ISSN: | 2255-534X |