TBA (26S136)

Empirical Bile Acid Sequestrant Treatment for Chronic Watery Diarrhoea: A Real-World Audit

Author(s)

E Vallely (1) , L Barry (2) , W Stack (1,2)

Department(s)/Institutions

1. School of Medicine, University College Cork 2. Department of Gastroenterology & Gastro-intestinal Physiology, Bon Secours Hospital, Cork

Introduction

Bile acid malabsorption (BAM) is an underdiagnosed cause of chronic diarrhoea, present in one-third to one-half of patients with unexplained chronic diarrhoea frequently labelled as IBS-D. UEG/ESNM guidelines recommend SeHCAT testing or an empirical trial of bile acid sequestrants (BAS) in such patients. However, SeHCAT testing is not widely available in clinical practice.

Aims/Background

To evaluate symptomatic response to empirical BAS therapy in patients presenting with chronic watery diarrhoea.

Method

An audit was conducted of 95 consecutive patients presenting with watery diarrhoea (Bristol Stool Chart 6-7) between January and December 2025. Coeliac disease was excluded serologically, and all patients underwent colonoscopy with biopsy to exclude microscopic colitis/IBD. BAS was prescribed empirically and treatment response was recorded.

Results

95 patients were included (58 female, 37 male; mean age 56.9 years). Mean duration of symptoms was 4.7 years (range 6 months - 11 years). All patients were prescribed Colesevelam (Cholestagel 625mg BD/TDS to response). Of 62 patients with follow-up data to date, 19 (30.6%) had prior cholecystectomy, and 1 (1.6%) a history of bowel resection. Significant symptomatic improvement was reported in 17/19 (89.5%) post-cholecystectomy patients. In the remaining 43 patients with negative investigations, 33 (76.7%) reported improvement, 9 (20.9%) no improvement, and 1 (2.3%) developed constipation. Overall, 50/62 (80.6%) reported symptomatic benefit.

Conclusions

Empirical BAS therapy was effective in over 80% of patients with longstanding chronic watery diarrhoea, supporting its role as a pragmatic, accessible first-line approach in this cohort of patients.