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. 2000 Feb;46(2):170–175. doi: 10.1136/gut.46.2.170

Role of bile acids and bile acid binding agents in patients with collagenous colitis

K Ung 1, R Gillberg 1, A Kilander 1, H Abrahamsson 1
PMCID: PMC1727822  PMID: 10644309

Abstract

BACKGROUND—In a retrospective study bile acid malabsorption was observed in patients with collagenous colitis.
AIMS—To study the occurrence of bile acid malabsorption and the effect of bile acid binders prospectively in patients with chronic diarrhoea and collagenous colitis.
METHODS—Over 36 months all patients referred because of chronic diarrhoea completed a diagnostic programme, including gastroscopy with duodenal biopsy, colonoscopy with biopsies, and the 75Se-homocholic acid taurine (75SeHCAT) test for bile acid malabsorption. Treatment with a bile acid binder (cholestyramine in 24, colestipol in three) was given, irrespective of the results of the 75SeHCAT test.
RESULTS—Collagenous colitis was found in 28 patients (six men, 22 women), 27 of whom had persistent symptoms and completed the programme. Four patients had had a previous cholecystectomy or a distal gastric resection. The 75SeHCAT test was abnormal in 12/27 (44%) of the collagenous colitis patients with 75SeHCAT values 0.5-9.7%, and normal in 15 patients (56%). Bile acid binding treatment was followed by a rapid, marked, or complete improvement in 21/27 (78%) of the collagenous colitis patients. Rapid improvement occurred in 11/12 (92%) of the patients with bile acid malabsorption compared with 10/15 (67%) of the patients with normal 75SeHCAT tests.
CONCLUSION—Bile acid malabsorption is common in patients with collagenous colitis and is probably an important pathophysiological factor. Because of a high response rate without serious side effects, bile acid binding treatment should be considered for collagenous colitis, particularly patients with bile acid malabsorption.


Keywords: bile acid malabsorption; collagenous colitis; diarrhoea; cholestyramine; colestipol

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Figure 1  .

Figure 1  

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75SeHCAT retention on day 7 in 27 patients with collagenous colitis.

Figure 2  .

Figure 2  

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Relation between stool frequency and bile acid malabsorption in patients with collagenous colitis. (A) The mean individual number of stools was negatively correlated to the 75SeHCAT retention on day 7 (p=0.02). (B) Box plot of stool frequency in patients with and without bile acid malabsorption.

Figure 3  .

Figure 3  

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Resolution of diarrhoea in 28 patients with collagenous colitis.

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