SP7.06 A review of the referral patterns for SeHCAT testing in patients with chronic diarrhoea - implications on diagnosis and management of Bile Acid Malabsorption

Introduction Bile acid malabsorption (BAM) arises from dysregulation of enterohepatic bile acid recycling and production. Patients usually present with chronic debilitating diarrhoea, usually to gastroenterology but also to many other different clinical specialties such as Lower GI with faecal incontinence etc. This study aims to evaluate the spectrum of referral patterns in our patients sent for SeHCAT testing over a five-year period. Methods Clinical data from medical records of 353 patients who underwent SeHCAT testing for suspected BAM from January 2019 for a five-year period was collected and analysed retrospectively. Results Of the 353 patients reviewed, 175 (49.57%) were diagnosed with BAM. The main referrers for SeHCAT were Gastroenterologists -272 patients (77.05%). The remaining 81 patients were largely referred by Colorectal surgeons with lower GI interest (41 patients); other referring specialties were as varied as other colorectal surgeons (7 patients) and upper GI, general medicine, care of the elderly, respiratory medicine and urology (33 patients). Of patients with BAM, 78.86% were referred from gastroenterology, 11.43% from Colorectal surgeons with lower GI interest, 1.14% from other colorectal surgeons and 8.5% from the mix of other specialties. Discussion Our findings highlight significant variations in the diagnosis and hence management of BAM. A high index of suspicion is essential in managing patients with chronic diarrhoea with risk factors for BAM as they can present with their symptoms to different specialties. These findings call for cross-specialty improved education regarding BAM diagnosis and management to improve outcomes in patients with BAM.