Imperial College London
Alternate

ProfessorJulianWalters

Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

Professor of Gastroenterology
 
 
 
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Contact

 

+44 (0)20 3313 2361julian.walters

 
 
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Location

 

Rm368, Hammersmith HouseHammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Sadowski:2020:jcag/gwz038,
author = {Sadowski, DC and Camilleri, M and Chey, WD and Leontiadis, GI and Marshall, JK and Shaffer, EA and Tse, F and Walters, JRF},
doi = {jcag/gwz038},
journal = {Journal of the Canadian Association of Gastroenterology},
pages = {e10--e27},
title = {Canadian association of gastroenterology clinical practice guideline on the management of bile acid diarrhea.},
url = {http://dx.doi.org/10.1093/jcag/gwz038},
volume = {3},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background and Aims: Chronic diarrhea affects about 5% of the population overall. Altered bile acid metabolism is a common but frequently undiagnosed cause. Methods: We performed a systematic search of publication databases for studies of assessment and management of bile acid diarrhea (BAD). The certainty (quality) of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation approach. Patient population, intervention, comparator and outcome questions were developed through an iterative process and were voted on by a group of specialists. Results: The certainty of evidence was generally rated as very low. Therefore, 16 of 17 recommendations are conditional. In patients with chronic diarrhea, consideration of risk factors (terminal ileal resection, cholecystectomy or abdominal radiotherapy), but not additional symptoms, was recommended for identification of patients with possible BAD. The group suggested testing using 75selenium homocholic acid taurine (where available) or 7α-hydroxy-4-cholesten-3-one, including patients with irritable bowel syndrome with diarrhea, functional diarrhea and Crohn's disease without inflammation. Testing was suggested over empiric bile acid sequestrant therapy (BAST). Once remediable causes are managed, the group suggested cholestyramine as initial therapy, with alternate BAST when tolerability is an issue. The group suggested against BAST for patients with extensive ileal Crohn's disease or resection and suggested alternative antidiarrheal agents if BAST is not tolerated. Maintenance BAST should be given at the lowest effective dose, with a trial of intermittent, on-demand administration, concurrent medication review and reinvestigation for patients whose symptoms persist despite BAST. Conclusions: Based on a systematic review, BAD should be considered for patients with chronic diarrhea. For patients with positive results from tests for BAD, a trial of BAS
AU  - Sadowski,DC
AU  - Camilleri,M
AU  - Chey,WD
AU  - Leontiadis,GI
AU  - Marshall,JK
AU  - Shaffer,EA
AU  - Tse,F
AU  - Walters,JRF
DO  - jcag/gwz038
EP  - 27
PY  - 2020///
SN  - 2515-2084
SP  - 10
TI  - Canadian association of gastroenterology clinical practice guideline on the management of bile acid diarrhea.
T2  - Journal of the Canadian Association of Gastroenterology
UR  - http://dx.doi.org/10.1093/jcag/gwz038
UR  - https://www.ncbi.nlm.nih.gov/pubmed/32010878
UR  - https://academic.oup.com/jcag/article/3/1/e10/5661094
UR  - http://hdl.handle.net/10044/1/76745
VL  - 3
ER  -
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