Role of bile acids and bile acid binding agents in patients with collagenous colitis

Abstract

Background: In a retrospective study bile acid malabsorption was observed in patients with collagenous colitis.

Aims: To study the occurrence of bile acid malabsorption and the effect of bile acid binders prospectively in patients with chronic diarrhoea and collagenous colitis.

Methods: Over 36 months all patients referred because of chronic diarrhoea completed a diagnostic programme, including gastroscopy with duodenal biopsy, colonoscopy with biopsies, and the (75)Se-homocholic acid taurine ((75)SeHCAT) test for bile acid malabsorption. Treatment with a bile acid binder (cholestyramine in 24, colestipol in three) was given, irrespective of the results of the (75)SeHCAT test.

Results: Collagenous colitis was found in 28 patients (six men, 22 women), 27 of whom had persistent symptoms and completed the programme. Four patients had had a previous cholecystectomy or a distal gastric resection. The (75)SeHCAT test was abnormal in 12/27 (44%) of the collagenous colitis patients with (75)SeHCAT values 0.5-9.7%, and normal in 15 patients (56%). Bile acid binding treatment was followed by a rapid, marked, or complete improvement in 21/27 (78%) of the collagenous colitis patients. Rapid improvement occurred in 11/12 (92%) of the patients with bile acid malabsorption compared with 10/15 (67%) of the patients with normal (75)SeHCAT tests.

Conclusion: Bile acid malabsorption is common in patients with collagenous colitis and is probably an important pathophysiological factor. Because of a high response rate without serious side effects, bile acid binding treatment should be considered for collagenous colitis, particularly patients with bile acid malabsorption.

Figure 1

⁷⁵SeHCAT retention on day 7 in 27 patients with collagenous colitis.

Figure 2

Relation between stool frequency and bile acid malabsorption in patients with collagenous colitis. (A) The mean individual number of stools was negatively correlated to the ⁷⁵SeHCAT retention on day 7 (p=0.02). (B) Box plot of stool frequency in patients with and without bile acid malabsorption.

Figure 3

Resolution of diarrhoea in 28 patients with collagenous colitis.