Abstract

Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea

Slattery SA1, Niaz O, Aziz Q, Ford AC, Farmer AD. Aliment Pharmacol Ther. 2015 Apr 27. doi: 10.1111/apt.13227. [Epub ahead of print]
 
     
Author information

1Neurogastroenterology Group, Blizard Institute of Cell & Molecular Science, Wingate Institute of Neurogastroenterology, Barts & the London School of Medicine & Dentistry, Queen Mary University of London, London, UK.

Abstract

BACKGROUND: Irritable bowel syndrome is a widespread disorder with a marked socioeconomic burden. Previous studies support the proposal that a subset of patients with features compatible with diarrhoea-predominant IBS (IBS-D) have bile acid malabsorption (BAM).

AIMS: To perform a systematic review and meta-analysis to assess the prevalence of BAM in patients meeting the accepted criteria for IBS-D.

METHODS: MEDLINE and EMBASE were searched up to March 2015. Studies recruiting adults with IBS-D, defined by the Manning, Kruis, Rome I, II or III criteria and which used 23-seleno-25-homotaurocholic acid (SeHCAT) testing for the assessment of BAM were included. BAM was defined as 7 day SeHCAT retention of <10%. We calculated the rate of BAM and 95% confidence intervals (CI) using a random effects model. The methodological quality of included studies was evaluated using the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2).

RESULTS: The search strategy identified six relevant studies comprising 908 individuals. The rate of BAM ranged from 16.9% to 35.3%. The pooled rate was 28.1% (95% CI: 22.6-34%). There was significant heterogeneity in effect sizes (Q-test χ2 = 17.9, P < 0.004; I2 = 72.1%). The type of diagnostic criteria used or study country did not significantly modify the effect.

CONCLUSIONS: These data provide evidence that in excess of one quarter of patients meeting accepted criteria for IBS-D have bile acid malabsorption. This distinction has implications for the interpretation of previous studies, as well as contemporaneous clinical practice and future guideline development.

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