Management of bile acid malabsorption using low-fat dietary interventions: a useful strategy applicable to some patients with diarrhoea-predominant irritable bowel syndrome?

Watson, Lorraine; Lalji, Amyn; Bodla, Shankar; Muls, Ann; Andreyev, H. J. N.; Shaw, Clare

doi:10.7861/clinmedicine.15-6-536

Cited by 32 publications

(53 citation statements)

References 29 publications

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“…Previous studies have shown that dietary fat intake limited to 20% of daily calorie intake can be maintained by patients long term. 6 The use of low-fat dietary intervention in the management of BAM has been overlooked in national guidelines. 6 The use of such dietary intervention can have a significant impact on GI symptoms and quality of life also improved as scored in this study.…”

Section: Discussionmentioning

confidence: 99%

“…21,23 , 28-30 Our findings are also consistent with a smaller study from our unit in a separate population of 40 patients assessed using a different numerical symptom scoring tool published in 2015. 6 Dietary fat intake was assessed via 7-day food diaries, which has been shown to have far greater accuracy than a 24-hour dietary recall. 31 All food diaries were analysed by one of two dietitians.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were asked to complete a 7-day food diary for their initial consultation with a registered dietitian and then advised on a personalised low-fat dietary intervention, aiming to provide 20% of total daily energy from all types of ingested dietary fat. 6 Patients attended a follow-up appointment with the dietitian 4-12 weeks later at which they brought a 7-day food diary or provided dietary recall and rated their GI symptoms again on the GSRS.…”

Section: Methodsmentioning

confidence: 99%

“…6 Patients requiring a bile acid sequestrant had their dose optimised before receiving dietary advice. Patients were asked to complete a 7-day food diary for their initial consultation with a registered dietitian and then advised on a personalised low-fat dietary intervention, aiming to provide 20% of total daily energy from all types of ingested dietary fat.…”

Section: Methodsmentioning

confidence: 99%

“…This results in loose stool and potentially in a number of other symptoms, which can include urgency of defecation, abdominal bloating/cramps, flatulence, abdominal pain, steatorrhoea and nocturnal defecation. [4][5][6] Constipation (following episodes of diarrhoea) is rated as the worst symptom in 20% of those affected in one study. 4 Symptoms are often severe, for example, chronic episodic faecal incontinence in up to half of all patients.…”

Section: Introductionmentioning

confidence: 99%

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The efficacy of a low-fat diet to manage the symptoms of bile acid malabsorption – outcomes in patients previously treated for cancer

et al. 2017

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Dietary fat ingestion triggers bile secretion into the gastrointestinal tract. Bile acid malabsorption affects >1% of the population, causing loose stool and other gastrointestinal symptoms. The diagnosis is frequently missed. Treatments are often considered ineffective. We evaluated low-fat diets for managing gastrointestinal symptoms in these patients. All patients reporting type 6 or 7 stool were offered a selenium-75 homocholic acid taurine (SeHCAT) scan. Prospective data in patients with 7-day scan retention <20% were analysed. Patients requiring a bile acid sequestrant were given this before receiving dietary advice. Patients completed a 7-day food diary before dietetic consultations. Personalised dietary interventions, providing 20% of daily energy from fat, were prescribed. Symptoms were assessed using a modifi ed gastrointestinal symptom rating scale questionnaire before and 4-12 weeks after dietary intervention. A total of 114 patients (49 male, median age 64 years, median body mass index 27 kg/m 2 ) were evaluated. 44% of these patients were taking colesevelam. After dietary intervention, there was statistically signifi cant improvement in abdominal pain and nocturnal defecation (0.2% alpha, p=0.001). Improvement in bowel frequency, urgency, fl atulence, belching, borborygmi and stool consistency were seen, but did not reach statistical signifi cance (p≤0.004-0.031). Dietary intervention is an effective treatment option for patients with symptomatic bile acid malabsorption and should be routinely considered. ABSTRACTThe efficacy of a low-fat diet to manage the symptoms of bile acid malabsorption -outcomes in patients previously treated for cancer

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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