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How bad is bile acid diarrhoea: an online survey of patient-reported symptoms and outcomes
  1. Ayman Bannaga1,
  2. Lawrence Kelman2,
  3. Michelle O'Connor2,,3,
  4. Claire Pitchford2,
  5. Julian R F Walters4,
  6. Ramesh P Arasaradnam1,,5,6
  1. 1Department of Gastroenterology, University Hospital Coventry and Warwickshire, Coventry, UK
  2. 2BAM Facebook Group, Coventry, UK
  3. 3BAM Support UK, Coventry, UK
  4. 4Digestive Diseases Division, Imperial College London, London, UK
  5. 5University of Warwick, Coventry, UK
  6. 6University of Coventry, Coventry, UK
  1. Correspondence to Professor Ramesh P Arasaradnam; r.arasaradnam{at}


Objectives Bile acid diarrhoea (BAD) is an underdiagnosed condition producing diarrhoea, urgency and fear of faecal incontinence. How patients experience these symptoms has not previously been studied. Bile Acid Malabsorption (BAM) Support UK was established in 2015 as a national charity with objectives including to provide details regarding how BAD affects patients, to improve earlier recognition and clinical management.

Design, setting and main outcome A questionnaire was collected anonymously by BAM Support UK and the Bile Salt Malabsorption Facebook group over 4 weeks at the end of 2015. It comprised 56 questions and aimed to inform patients and clinicians about how BAD affects the respondents.

Results The first 100 responses were analysed. 91% of the respondents reported a diagnosis of BAD. 58% of total respondents diagnosed following a Selenium-homocholic acid taurine scan, 69% were diagnosed by a gastroenterologist, with type 2 and 3 BAD comprising 38% and 37%, respectively, of total respondents. Symptoms had been experienced for more than 5 years before diagnosis in 44% of respondents. Following treatment, usually with bile acid sequestrants, 60% of participants reported improvement of diarrhoea and most reported their mental health has been positively impacted. Just over half of the cohort felt as though their symptoms had been dismissed during clinical consultations and 28% felt their GPs were unaware of BAD.

Conclusions BAD requires more recognition by clinicians to address the current delays in diagnosis. Treatment improves physical and mental symptoms in the majority of participants.


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