eP230 A review of the spectrum of causes of Bile Acid Malabsorption – does cholecystectomy play a significant part?

Introduction Bile acid malabsorption (BAM) arises from dysregulation of enterohepatic bile acid recycling/ production, manifesting as chronic Bile acid diarrhoea (BAD). This is Type 2 BAD (previously idiopathic/Primary BAM) with no small bowel (SB) disorder, Type 3 BAD (with GI diseases eg celiac, pancreatitis, small intestinal bacterial overgrowth (SIBO), post-radiation, post-cholecystectomy) or Type1 BAD (with inflammation (Crohn’s) or SB resection) – latter 2 previously Secondary BAM. This study aimed to evaluate the spectrum of causes of BAM in our patients, especially those post-cholecystectomy. Methods Clinical data was analysed retrospectively from medical records of 353 patients who underwent SeHCAT testing for suspected BAM from January 2019 for a five-year period, including likely cause. Results Of the 353 patients reviewed, 175 (49.57%) were diagnosed with BAM. Of these, 43% were Idiopathic/Primary BAM. We found the most common cause of Secondary BAM to be post-cholecystectomy (23.29%); others included Crohn’s (8.5%), post-right hemicolectomy (3.4%), bowel resection (3.9%), celiac (1.7%), post-radiation (1.13%), metformin (0.56%), etc. Conclusion There needs to be high index of suspicion and appropriate SeHCAT testing for confirmation of BAM in patients with chronic diarrhoea, especially those with significant risk factors, to ensure appropriate management. Although most of our patients were found to have idiopathic BAM, of those patients with secondary BAM, cholecystectomy was undeniably the most significant cause. It is therefore very important for general surgeons to counsel patients undergoing cholecystectomy regarding the possibility of BAD postoperatively, due to the very significant impact this can have on their quality of life.