An evaluation of the use of serum 7-alpha-hydroxycholestenone as a diagnostic test of bile acid malabsorption causing watery diarrhea
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An evaluation of the use of serum 7-alpha-hydroxycholestenone as a diagnostic test of bile acid malabsorption causing watery diarrhea. / Brydon, W Gordon; Culbert, Pearl; Kingstone, Kathleen; Jarvie, Ann; Iacucci, Marietta; Tenhage, Merel; Ghosh, Subrata.
In: Canadian Journal of Gastroenterology, Vol. 25, No. 6, 06.2011, p. 319-23.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - An evaluation of the use of serum 7-alpha-hydroxycholestenone as a diagnostic test of bile acid malabsorption causing watery diarrhea
AU - Brydon, W Gordon
AU - Culbert, Pearl
AU - Kingstone, Kathleen
AU - Jarvie, Ann
AU - Iacucci, Marietta
AU - Tenhage, Merel
AU - Ghosh, Subrata
PY - 2011/6
Y1 - 2011/6
N2 - BACKGROUND: Bile acid malabsorption (BAM) is a recognized cause of watery diarrhea, often diagnosed empirically based on clinical response to cholestyramine. The radionuclide selenium-labelled homocholic acid-taurine whole body retention test is expensive, labour intensive and of limited availability.OBJECTIVE: To report on the clinical performance of serum 7-alphahydroxy-4-cholesten-3-one (7HCO) as a test of BAM in adult patients with unexplained diarrhea.METHODS: Patients with unexplained diarrhea were investigated over a three-year period. Final diagnosis was determined based on medical history and investigations, serum levels of 7HCO and response to cholestyramine. ROC analysis was used to determine the ideal upper reference range cut-off value to optimize sensitivity/specificity for BAM. Time of blood specimen collection was recorded to investigate possible variation in results throughout the working day.RESULTS: ROC analysis yielded a sensitivity/specificity of 90%/77% for type 1 BAM (ileal disease/resection) and 97%/74% for type 2 BAM (idiopathic) using 30 ng/mL as the upper limit of normal for serum 7HCO when compared with all other patients. Of 813 patients, 196 tested positive. Serum 7HCO levels were significantly higher in blood specimens that were collected between 12:00 and 13:00 (median 24 ng/mL) than in specimens collected between 09:00 and 10:00 (median 17 ng/mL) (P<0.05).CONCLUSION: Serum 7HCO testing is a simple, sensitive, noninvasive, inexpensive alternative to other more commonly used tests for BAM. Time of specimen collection, however, resulted in small but significant result variations and, although unlikely to have much impact on test value, it should ideally be standardized.
AB - BACKGROUND: Bile acid malabsorption (BAM) is a recognized cause of watery diarrhea, often diagnosed empirically based on clinical response to cholestyramine. The radionuclide selenium-labelled homocholic acid-taurine whole body retention test is expensive, labour intensive and of limited availability.OBJECTIVE: To report on the clinical performance of serum 7-alphahydroxy-4-cholesten-3-one (7HCO) as a test of BAM in adult patients with unexplained diarrhea.METHODS: Patients with unexplained diarrhea were investigated over a three-year period. Final diagnosis was determined based on medical history and investigations, serum levels of 7HCO and response to cholestyramine. ROC analysis was used to determine the ideal upper reference range cut-off value to optimize sensitivity/specificity for BAM. Time of blood specimen collection was recorded to investigate possible variation in results throughout the working day.RESULTS: ROC analysis yielded a sensitivity/specificity of 90%/77% for type 1 BAM (ileal disease/resection) and 97%/74% for type 2 BAM (idiopathic) using 30 ng/mL as the upper limit of normal for serum 7HCO when compared with all other patients. Of 813 patients, 196 tested positive. Serum 7HCO levels were significantly higher in blood specimens that were collected between 12:00 and 13:00 (median 24 ng/mL) than in specimens collected between 09:00 and 10:00 (median 17 ng/mL) (P<0.05).CONCLUSION: Serum 7HCO testing is a simple, sensitive, noninvasive, inexpensive alternative to other more commonly used tests for BAM. Time of specimen collection, however, resulted in small but significant result variations and, although unlikely to have much impact on test value, it should ideally be standardized.
KW - Adult
KW - Anticholesteremic Agents
KW - Bile Acids and Salts
KW - Cholestenones
KW - Cholestyramine Resin
KW - Comparative Effectiveness Research
KW - Diarrhea
KW - Female
KW - Humans
KW - Malabsorption Syndromes
KW - Male
KW - ROC Curve
KW - Radionuclide Imaging
KW - Time Factors
KW - Journal Article
M3 - Article
C2 - 21766092
VL - 25
SP - 319
EP - 323
JO - Canadian Journal of Gastroenterology
JF - Canadian Journal of Gastroenterology
SN - 0835-7900
IS - 6
ER -