Which diagnostic tests are recommended for confirming bile acid malabsorption in primary care?

Diagnostic tests recommended for confirming bile acid malabsorption (BAM) in primary care:

• Currently, there is no specific diagnostic test for bile acid malabsorption routinely recommended in primary care settings according to UK guidelines.
• Diagnosis of BAM is generally considered when chronic diarrhoea persists and other common causes (such as coeliac disease, inflammatory bowel disease, infections) have been excluded through blood tests and stool investigations.
• Primary care investigations for chronic diarrhoea include blood tests (full blood count, liver function, inflammatory markers, coeliac serology) and stool tests to exclude infections and inflammatory causes, but these do not directly confirm BAM.
• Referral to secondary care is advised if BAM is suspected, where specialised tests such as SeHCAT (selenium-75 homocholic acid taurine) scan may be performed to confirm bile acid malabsorption.
• In primary care, a clinical suspicion of BAM may arise particularly in patients with chronic diarrhoea and a history of ileal resection or cholecystectomy, but confirmation requires specialist assessment.

Therefore, in primary care, the approach is to exclude other causes of diarrhoea with standard blood and stool tests and then refer for specialist testing if BAM is suspected.

Summary: No specific diagnostic test for BAM is recommended in primary care; diagnosis relies on exclusion of other causes and referral for specialist tests like SeHCAT scan.

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