Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026
A single test strategy using spot fecal bile acid test may be a feasible strategy for the diagnosis of bile acid malabsorption.
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Mehta Shubham, Agarwal Samagra, Pachisia Aditya Vikram, Sachdev Vikas, Agarwal Ankit, Vignesh Dwarakanathan, Chauhan Ashish, Madan Divya, Chaudhari Bodhisattya Roy, Prasad Shubham, Sarda Radhika, Sengupta Abhinav, Rajput Mahendra Singh, Kedia Saurabh, Ahuja Vineet, Makharia Govind K
Аннотация
BACKGROUND: Bile acid malabsorption (BAM) is often missed in patients with chronic diarrhea as diagnostic tests are technically challenging and not available widely. Quantitative estimation of fecal bile acids (FBA) in a single stool sample has been reported recently for the diagnosis of BAM and may be easily applied.
METHODS: We performed a pilot observational cross-sectional study to estimate the optimal FBA cut-point for the diagnosis of BAM, using the IDK® Bile Acid test, an enzymatic spectrophotometry-based assay for measuring total stool bile acids. We estimated FBA concentrations in healthy adults (n = 100; negative controls) and patients with known ileal Crohn's disease (n = 67; positive controls), generating a receiver-operator characteristics (ROC) curve for assessing its diagnostic accuracy. FBA levels were then assessed in three groups of patients, namely diarrhea-predominant irritable bowel syndrome (IBS-D) and functional diarrhea (FD) (n = 100), post-cholecystectomy (n = 100) and ileal tuberculosis (n = 33).
RESULTS: Optimal cut-off point for FBA was identified at 2.8 µg/g (sensitivity = 89.5%; specificity = 92.0%; area under ROC = 0.959 [95%CI = 0.929-0.989]), with median FBA in healthy controls (1.5 [IQR = 0.7-2.2]) being significantly lower than that in patients with ileal Crohn's disease (6.0 [IQR = 4.7-8.0]; p < 0.001). Median FBA in patients with IBS-D/FD, post-cholecystectomy and those with ileal tuberculosis were 2.0 (IQR = 1-2.8), 3.4 (IQR = 1.7-5.3) and 3.0 (IQR = 2.2-4.6), respectively. Overall, 21%, 57% and 54.5% of patients with IBS-D/FD, post-cholecystectomy and ileal tuberculosis had BAM.
CONCLUSIONS: We demonstrate the feasibility of quantitative estimation of fecal bile acids in a single stool sample to diagnose BAM.
METHODS: We performed a pilot observational cross-sectional study to estimate the optimal FBA cut-point for the diagnosis of BAM, using the IDK® Bile Acid test, an enzymatic spectrophotometry-based assay for measuring total stool bile acids. We estimated FBA concentrations in healthy adults (n = 100; negative controls) and patients with known ileal Crohn's disease (n = 67; positive controls), generating a receiver-operator characteristics (ROC) curve for assessing its diagnostic accuracy. FBA levels were then assessed in three groups of patients, namely diarrhea-predominant irritable bowel syndrome (IBS-D) and functional diarrhea (FD) (n = 100), post-cholecystectomy (n = 100) and ileal tuberculosis (n = 33).
RESULTS: Optimal cut-off point for FBA was identified at 2.8 µg/g (sensitivity = 89.5%; specificity = 92.0%; area under ROC = 0.959 [95%CI = 0.929-0.989]), with median FBA in healthy controls (1.5 [IQR = 0.7-2.2]) being significantly lower than that in patients with ileal Crohn's disease (6.0 [IQR = 4.7-8.0]; p < 0.001). Median FBA in patients with IBS-D/FD, post-cholecystectomy and those with ileal tuberculosis were 2.0 (IQR = 1-2.8), 3.4 (IQR = 1.7-5.3) and 3.0 (IQR = 2.2-4.6), respectively. Overall, 21%, 57% and 54.5% of patients with IBS-D/FD, post-cholecystectomy and ileal tuberculosis had BAM.
CONCLUSIONS: We demonstrate the feasibility of quantitative estimation of fecal bile acids in a single stool sample to diagnose BAM.