Rationale: Gut graft versus host disease (GvHD) in patients post stem cell transplantation is associated with malabsorption and malnutrition. The purpose of this study was to examine the causes of malnutrition and assess modes of delivery of artificial nutritional support.Methods: This was a retrospective study of patients who had undergone allogenic stem cell transplantation from January 2009 to December 2017 at UCLH and were referred to the hospital nutrition support team with gut GvHD.

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IntroductionBile acid malabsorption (BAM) is diagnosed by a reduced day 7 retention of bile acid at tauroselcholic [75selenium] acid (SeHCAT) scan. Currently there is little consensus on its use in the diagnosis of BAM in patients with unexplained diarrhoea [1]. At our site, we have adopted a “test and treat” strategy rather than empirical therapy with bile acid sequestrants in patients with unexplained diarrhoea.In this retrospective study, we have examined the diagnostic yield of SeHCAT in our clinical practice.MethodPatients who underwent SeHCAT scans between December 2012 to March 2016 were included in the study. Patients who had incomplete scans were excluded.≤15% bile acid retention at day 7 was regarded as mild BAM, ≤10% retention as moderate BAM, and ≤5% retention as severe BAM. Clinic letters were subsequently reviewed to ascertain causes of BAM.ResultsSeHCAT scans were performed on 332 patients during the study period. One patient was excluded due to incomplete scan. Of the remaining 331 patients, 174 (53%) patients had normal scans, and 157 (47%) were diagnosed with BAM (63 severe, 43 moderate, 51 mild). Of the 157 patients who were diagnosed with BAM, 93 (59%) were type 2 (Idiopathic), followed by 39 (25%) type 1 (Terminal ileal pathology) and 25 (16%) type 3 (Other GI causes). Because of the size of the subgroups, further analysis was not possible.ConclusionA high proportion (47%) of those who underwent SeHCAT scan were diagnosed with BAM. This exceeds the recently published meta-analysis data on the prevalence of BAM (16.9%>35.3%, pooled rate 28.1%) [2]. This may be because of a higher than usual pre-test probability since all patients had already undergone comprehensive investigations for other causes of chronic diarrhoea.Type 2 BAM predominated (60%) and the majority had mild or moderate malabsorption. Anecdotally, response rates to therapy in this group are variable and we have noticed that diagnostic confidence may increase patient compliance and satisfaction with treatment. This retrospective data seems to support a “test and treat” strategy in the management of bile acid diarrhoea.References. NICE diagnostic guidance DG7 (Nov 2012, reviewed Nov 2015)- SeHCAT for the investigation of diarrhoea due to bile acid malabsorption in people with diarrhoea-predominant irritable bowel syndrome (IBD-D) or Crohn’s disease without ileal resection.. Slattery SA, et al. Systematic review with meta-analysis: The prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea. Alimentary Pharmacology and Therapeutics, 2015Jul;42(1):3–11.Disclosure of InterestNone Declared

IntroductionEmerging evidence in the literature has suggested fibroblast growth factor 19 (FGF19) and the farnesoid X receptor (FXR) are integral in bile acid synthesis, glucose and lipid metabolism. Reduced level of FGF19 and reduced feedback via the FXR are associated with idiopathic bile acid malabsorption (BAM) and non-alcoholic fatty liver disease (NAFLD), leading to the research and development of FXR agonists as potential treatment.In this retrospective case control study, we examined the correlation between BAM and NAFLD in the district general hospital population in light of recent findings in the literature.MethodPatients who had tauroselcholic [ 75selenium] acid (SeHCAT) scan (Defined as <15% bile acid retention at day 7) between December 2012 to March 2016, with additional liver imaging (Ultrasound, CT, MRI) were included in the study. Patients with normal SeHCAT and fatty liver disease on imaging were identified as the control group. Patients with incomplete SeHCAT scans, and patients who had SeHCAT scan but no additional liver imaging were excluded from the study. Clinic letters were subsequently reviewed to ascertain cause of BAM and fatty liver disease. Patients with a diagnosis of alcoholic fatty liver disease were excluded.ResultsBAM subgroup analysis- 93 type 2 (idiopathic), 39 type 1 (Terminal ileal pathology), 25 type 3 (Other GI causes). Further subgroup analysis was not possible, but the majority of the included patients had Type 2 BAM.ConclusionOur study has shown that in patients with BAM who subsequently had liver imaging, 34% were also diagnosed with NAFLD. In comparison only 11.96% in the control group were diagnosed with NAFLD (p=0.0003, OR=3.8). It is likely that patients with Type 2 BAM are over represented, but that is reflective of our clinical experience. An expanded bile acid pool in these patients may be mechanistic by increasing LDL cholesterol and reducing HDL cholesterol. A number of other factors have recognised influences on hepatic fat metabolism and the progressive impact of bile acid sequestration on the hepatic bile acid pool and subsequent hepatic fat load is uncertain.In summary, the increased prevalence of NAFLD in patients with BAM may indicate clinical value in screening these malabsorptive patients with hepatic ultrasound. Bile acid sequestration may have little impact on reducing hepatic fat, but there may be benefit from addressing lifestyle factors such as exercise and weight loss.Disclosure of InterestNone DeclaredAbstract OC-023 Figure 1