Matthew Kurien1, Elizabeth Thurgar2, Ashley Davies2, Ron Akehurst2, Jervoise Andreyev3. 1. Academic Unit of Gastroenterology, Department of Infection, Immunity and Cardiovascular Sciences, University of Sheffield, Sheffield, UK. 2. BresMed Health Solutions, Sheffield, UK. 3. The GI and Nutrition Team, The Royal Marsden NHS Foundation Trust, London, UK.
Abstract
BACKGROUND: In 2012, the National Institute for Health and Care Excellence (NICE) assessed guidance (DG7) on the use of tauroselcholic (75selenium) acid (also known as SeHCAT) for the investigation of diarrhoea due to bile acid malabsorption (BAM) in patients with IBS-D and in patients with Crohn's disease who have not had an ileal resection. NICE concluded that tauroselcholic (75selenium) acid was recommended for use in research only. NICE will be reviewing the decision to update the guidance for tauroselcholic (75selenium) acid, for these populations, in March 2017. AIM: Our aim is to summarise advances in BAM, also known as bile acid diarrhoea (BAD), and encourage clinicians to re-evaluate their understanding of this disorder. APPROACH: We review the prevalence, diagnosis and treatment of BAD/BAM. We describe the new evidence available since the original NICE review in 2012, and discuss the economic issues associated with failure to diagnose or to treat BAD/BAM accurately. EVIDENCE UPDATE: There is new and compelling evidence available since DG7, which shows that tauroselcholic (75selenium) acid scanning is a powerful tool in the diagnosis of BAD/BAM. We summarise published prevalence data (approximately 1% prevalence in the UK, as suggested by clinical practice diagnosis rates), and highlight that the true prevalence of BAD/BAM could be far greater than this. CONCLUSION: We present evidence that challenges current opinion about this disorder, and we commend both clinicians and health technology assessment (HTA) agencies for being open to arguments and new evidence in any future HTAs.
BACKGROUND: In 2012, the National Institute for Health and Care Excellence (NICE) assessed guidance (DG7) on the use of tauroselcholic (75selenium) acid (also known as SeHCAT) for the investigation of diarrhoea due to bile acid malabsorption (BAM) in patients with IBS-D and in patients with Crohn's disease who have not had an ileal resection. NICE concluded that tauroselcholic (75selenium) acid was recommended for use in research only. NICE will be reviewing the decision to update the guidance for tauroselcholic (75selenium) acid, for these populations, in March 2017. AIM: Our aim is to summarise advances in BAM, also known as bile acid diarrhoea (BAD), and encourage clinicians to re-evaluate their understanding of this disorder. APPROACH: We review the prevalence, diagnosis and treatment of BAD/BAM. We describe the new evidence available since the original NICE review in 2012, and discuss the economic issues associated with failure to diagnose or to treat BAD/BAM accurately. EVIDENCE UPDATE: There is new and compelling evidence available since DG7, which shows that tauroselcholic (75selenium) acid scanning is a powerful tool in the diagnosis of BAD/BAM. We summarise published prevalence data (approximately 1% prevalence in the UK, as suggested by clinical practice diagnosis rates), and highlight that the true prevalence of BAD/BAM could be far greater than this. CONCLUSION: We present evidence that challenges current opinion about this disorder, and we commend both clinicians and health technology assessment (HTA) agencies for being open to arguments and new evidence in any future HTAs.
Authors: Oluwafikunayo Orekoya; John McLaughlin; Eugenia Leitao; Wendy Johns; Simon Lal; Peter Paine Journal: Clin Med (Lond) Date: 2015-06 Impact factor: 2.659
Authors: Jervoise Andreyev; Paul Ross; Clare Donnellan; Elaine Lennan; Pauline Leonard; Caroline Waters; Linda Wedlake; John Bridgewater; Rob Glynne-Jones; William Allum; Ian Chau; Richard Wilson; David Ferry Journal: Lancet Oncol Date: 2014-09 Impact factor: 41.316
Authors: D J Gracie; J S Kane; S Mumtaz; A F Scarsbrook; F U Chowdhury; A C Ford Journal: Neurogastroenterol Motil Date: 2012-07-05 Impact factor: 3.598
Authors: Imran Aziz; Saqib Mumtaz; Hassan Bholah; Fahmid U Chowdhury; David S Sanders; Alexander C Ford Journal: Clin Gastroenterol Hepatol Date: 2015-03-10 Impact factor: 11.382
Authors: Nelson Valentin; Michael Camilleri; Osama Altayar; Priya Vijayvargiya; Andres Acosta; Alfred D Nelson; M Hassan Murad Journal: Gut Date: 2015-09-07 Impact factor: 23.059
Authors: H Jervoise N Andreyev; Ann C Muls; Christine Norton; Charlotte Ralph; Lorraine Watson; Clare Shaw; James O Lindsay Journal: Frontline Gastroenterol Date: 2014-06-17
Authors: Ayman Bannaga; Lawrence Kelman; Michelle O'Connor; Claire Pitchford; Julian R F Walters; Ramesh P Arasaradnam Journal: BMJ Open Gastroenterol Date: 2017-01-19
Authors: Jennifer A Summers; Janet Peacock; Bolaji Coker; Viktoria McMillan; Mercy Ofuya; Cornelius Lewis; Stephen Keevil; Robert Logan; John McLaughlin; Fiona Reid Journal: BMJ Open Gastroenterol Date: 2016-05-25
Authors: Ramesh P Arasaradnam; Steven Brown; Alastair Forbes; Mark R Fox; Pali Hungin; Lawrence Kelman; Giles Major; Michelle O'Connor; Dave S Sanders; Rakesh Sinha; Stephen Charles Smith; Paul Thomas; Julian R F Walters Journal: Gut Date: 2018-04-13 Impact factor: 23.059