Bile Acid Malabsorption: Major Unrecognized Cause of Diarrhea in Cancer Patients

Results from a recent study show that weak bile acid absorption leads to chronic diarrhea among cancer patients.

Led by Jervoise Andreyev, MD, PhD, consultant gastroenterologist at the Royal Marsden Hospital, the study’s primary goal was to provide the foundation for a more focused approach to manage complaints of diarrhea in cancer patients. It included a total of 506 patients afflicted with diarrhea and various cancers, over a 4-year time frame. Results showed that 43% of patients had bile acid malabsorption (BAM), which alluded to a potential opportunity to improve quality of life in these patients.

The patients suffering from chronic diarrhea were tested with selenium homocholic acid taurine (SeHCAT), a radiolabeled bile acid analog readily measured with a gamma camera without the necessity of stool samples. The study noted the BAM rates were especiallyincreased in patients with cancers surrounding the upper pelvis.

Results indicated that among urologic conditions, BAM was more common in patients with bladder cancer (50%) than in patients with prostate cancer (22%). Similar BAM rates were found in tumors involving the endometrium (42%) relative to vulvovaginal tissues (less than 20%). Also, for gastrointestinal cancers, BAM was identified more frequently in those with disease s afflicting the lower tract (50%) than the upper (35%).

Frank Phillips, MD, a trainee gastroenterologist at the Royal Marsden Hospital, in London, England, said, “Control of BAM to relieve chronic diarrhea improves quality of life and can prevent interruptions in cancer therapy.”

Experts had commented on the limited availability of diagnostic tests for BAM, which poses an issue for patients with cancer-related diarrhea. However, it had been deemed the best option considering the currentvoid in choices. It was suggested that a response to bile acid sequestrants could be considered “supportive evidence” for BAM as a cause of diarrhea afflicted patients.

Additionally, according to John K. DiBaise, MD, professor of medicine in the Division of Gastroenterology and Hepatology at Mayo Clinic, in Scottsdale, AZ,“Use of bile acid sequestrants is often poorly tolerated and the response variable. I find it difficult to strongly recommend this strategy without a definitive diagnosis or at least a very high index of suspicion.”