Bile acid malabsorption (BAM) is often misdiagnosed as Irritable Bowel Syndrome or is overlooked in individuals with Crohn’s disease.

Bile Acid Malabsorption happens when the small intestine is unable to direct bile acid back to the liver. This means that the body doesn’t absorb water properly and affects digestion. The condition results in what is known as Bile Acid Diarrhoea.

How will a new test for Bile Acid Malabsorption be developed?

Currently, the only test for bile acid malabsorption is the SeHCAT test which is expensive, time consuming and uses radiation.

The team have developed a test which they believe will diagnose the condition more rapidly and cost effectively than the current test. For its initial testing phase, it will be used on stool (poo) samples, and in its second phase the research team will assess whether it can also guide treatment decisions on what dose should be given to individual patients.

The aim of the study is to establish a better test for BAM, do the groundwork for a future study of the role of faecal bile acid measurements within the NHS, and use the data collected from this trial to prepare other studies to assist with the diagnosis and treatment of individuals with BAM.

The research team

The research will be led by Dr Matthew Brookes at the Royal Wolverhampton NHS Trust and involve collaboration with Professor John McLaughlin at the University of Manchester Institute of Inflammation and Repair and Dr Helen Steed and Professor Rousseau Gama, both at the Royal Wolverhampton NHS Trust.

Why diagnose bile acid malabsorption?

Chronic diarrhoea is one of the most common reasons why people get referred to specialist gastroenterology clinics, and can account for as many as 1 in 20 referrals. Bile acid malabsorption is a major cause of chronic diarrhoea and is thought to affect up to 1 million people in the UK.

As well as individuals with Crohn’s disease, as many as one in three people diagnosed with IBS with diarrhoea (IBS-D) may actually be experiencing BAM but the current gold standard SeCHAT test is only available in certain UK centres. It is also time consuming and costly.

In 2012 the National Institute for Health and Care Excellence’s Diagnostic Advisory Group concluded that a new test for the diagnosis of BAM was needed.