B0271 - Comparison of Demographics, Colonic Transit, and Quality of Life in Patients With Bile Acid Diarrhea With and Without a History of Cholecystectomy

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Saam Dilmaghani, MD, MPH

Mayo Clinic
Rochester, MN

Saam Dilmaghani, MD, MPH, Wassel Sannaa, MBBS, Joelle BouSaba, MD, Michael Camilleri, MD
Mayo Clinic, Rochester, MN

Introduction: Introduction: Bile acid diarrhea (BAD) accounts for roughly 30% of patients diagnosed with functional diarrhea or diarrhea-predominant irritable bowel syndrome (IBS-D). Patients with BAD have unique biochemical, microbial, and mucosal findings as well as more rapid colonic transit when compared to IBS-D (PMID: 35580964). One cause of BAD in the absence of ileal resection or disease is cholecystectomy. Our aim was to compare demographics, colonic transit, and quality of life (QOL) in patients with BAD with and without a history of cholecystectomy.

Methods: Methods: We conducted a retrospective analysis of prospectively obtained data from a prior study (IRB #16-001445). Patients with intestinal resection or underlying gastrointestinal diseases were excluded. As part of the study, patients with biochemically confirmed BAD underwent measurement of colonic transit testing by validated scintigraphic method that utilizes ¹¹¹In-activated charcoal in a methacrylate-coated delayed release capsule. Patients also completed the IBS-QOL and Hospital Anxiety and Depression Scale (HADS) questionnaires. Baseline demographics and those measurements of patients with post-cholecystectomy BAD and idiopathic BAD were compared using median and interquartile range (IQR). Statistical testing between both groups utilized Chi-square, Fisher’s exact, or the Wilcoxon Rank Sum test as appropriate.

Results: Results: Among 44 patients with BAD, 36 (83.7%) were female with a median age of 46 years (IQR 35.5, 57.5) and body mass index (BMI) of 33.7 (IQR 29.9, 38.3). Fifteen (34.9%) patients had undergone cholecystectomy; these patients were older (p=0.024) with numerically higher BMI (p=0.09) compared to those without cholecystectomy. Similarly, those patients with BAD with and without cholecystectomy had similar colonic transit at 24 hours (p=0.696), and ascending colon emptying T_1/2 (p=0.261). Cholecystectomy did not appear to be associated with different levels of anxiety and depression based on the HADS (p=0.594) or reduced QOL based on the IBS-QOL (p=0.994). Patients with BAD and history of cholecystectomy were more likely to respond with worry about losing control of bowel function (Question 31 of IBS-QOL) (p=0.0296), but this did not meet statistical significance after adjustment for multiple comparisons.

Discussion: Discussion: Clinical features, QOL, and colonic transit times appear to be similar in BAD secondary to cholecystectomy or idiopathic BAD.

Characteristics [median (IQR) or N (%)]	BAD (N = 44)		p-value
Characteristics [median (IQR) or N (%)]	Prior cholecystectomy (N = 16)	No cholecystectomy (N = 28)	p-value
Number, % female	16 (100%)	28 (75%)	0.029
Age, years	56.5 (41.5, 65.0)	39.5 (33.5, 53.5)	0.024
Body mass index, kg/m²	34.5 (32.4, 39.4)	31.8 (28.4, 36.4)	0.09
Serum FGF-19, pg/mL	59.8 (25.1, 91.7)	59.1 (31.1, 110.6)	0.868
Serum 7αC4, ng/mL	74.3 (61.7, 104.0)	73.2 (60.0, 87.4)	0.508
Total fecal bile acids, µmol/g stool	4.9 (2.9, 6.7)	3.7 (2.4, 4.5)	0.097
Fecal primary bile acids (CDCA + CA), %	6.5 (1.0, 31.8)	20.0 (1.8, 53.8)	0.281
Colonic geometric center at 8 hours	1.4 (1.0, 2.9)	1.2 (0.6, 1.6)	0.238
Colonic geometric center at 24 hours	3.6 (2.2, 4.4)	3.4 (2.6, 3.8)	0.696
Ascending colon emptying T_1/2, hours	11.0 (4.4, 16.8)	13.9 (7.6, 18.1)	0.261
HADS score, % > 7	1 (6.3%)	3 (10.7%)	0.537
IBS-QOL, composite score*	32.0 (16.5, 44.9)	29.8 (17.6, 44.1)	0.930

Table: Comparison of patients with bile acid diarrhea (BAD) with and without history of cholecystectomy. *Calculation: [(participant score – minimum score) / (maximum score – minimum score)] x 100, where higher scores equate to worse quality of life. BAD, bile acid diarrhea; CA, cholic acid; CDCA, chenodeoxycholic acid; FGF, fibroblast growth factor; HADS, Hospital Anxiety and Depression Scale; IBS-QOL, Irritable Bowel Syndrome – Quality of Life; IQR, interquartile range

Disclosures:

Saam Dilmaghani indicated no relevant financial relationships.

Wassel Sannaa indicated no relevant financial relationships.

Joelle BouSaba indicated no relevant financial relationships.

Michael Camilleri: Aclipse Therapeutics – Consultant. Aditum Bio – Consultant. AEON Pharma – Consultant. Allergan – Grant/Research Support. Arena – Consultant. Bilayer Therapeutics – Stock Options. BioKier – Consultant. Coloplast – Consultant. Coloplast – Consultant. Colospan – Consultant. Cosmo Pharmaceuticals – Consultant. Dignify Therapeutics – Stock Options. Enterin – Stock Options. Fauna Bio – Consultant. GlaxoSmithKline – Consultant. Invea Therapeutics – Consultant. InveniAI – Consultant. Ironwood – Consultant. Kallyope – Consultant. NGM Biopharmaceuticals – Grant/Research Support. Novome – Consultant. Pfizer – Consultant. Protagonist Therapeutics – Consultant. Protagonist Therapeutics – Consultant. QED Therapeutics – Consultant. Sunovion Pharmaceuticals – Consultant. Takeda – Consultant. Thelium Therapeutics – Stock Options. Vanda – Grant/Research Support. VIPUN Medical – Consultant. Virios – Consultant. Zealand Biopharma – Consultant.

Saam Dilmaghani, MD, MPH, Wassel Sannaa, MBBS, Joelle BouSaba, MD, Michael Camilleri, MD. B0271 - Comparison of Demographics, Colonic Transit, and Quality of Life in Patients With Bile Acid Diarrhea With and Without a History of Cholecystectomy, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.