PTH-109 Management of Bile Acid Malabsorption (BAM) with Low Fat Dietary Interventions

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Abstract

Introduction

BAM is the unrecognised cause for loose stool for 500,000 people in the UK. It is increasingly recognised as a potential cause of distressing gastrointestinal (GI) symptoms after cancer treatment. This study aims to evaluate the efficacy of low fat dietary interventions in the management of BAM.

Methods

Patients with new onset GI symptoms after cancer treatment and a 7 day 23-selena-25-homochololytaurine (SeHCAT) scan <20%, were included in a prospective service evaluation. Patients were advised on a low fat dietary intervention by a Registered Dietitian, which aimed to provide 20% of total energy from fat. Patients rated their GI symptoms using a 10 point numerical rating scale, and completed 7 day dietary diaries, before and after dietary intervention. The dietary diaries were analysed using the dietplan6 dietary analysis programme. Significance of changes in symptom scores were analysed using Wilcoxon signed-ranks test, change in dietary fat intake using a paired t-test.

Results

40 patients (20 male, 20 female) with a median age 61 (range 22–90) years were recruited. The cancer diagnoses were GI (28%), gynaecological (30%), urological (30%) and other (12%). 7.5% had borderline BAM (15–20% 7 day retention), 25% mild BAM (10–15% retention), 17.5% moderate (5–10% retention) and 50% severe (<5% retention). 62.5% of patients were taking a bile acid sequestrant. Symptoms reported were urgency (83%), bloating (43%), increased frequency (43%), lack of control (40%), abdominal pain (38%), nocturnal defaecation (28%), incomplete evacuation (25%) and greasy/pale stools (23%). After dietary intervention, the mean scores for all symptoms decreased. There was a significant reduction in mean ratings for urgency, bloating, lack of control, bowel frequency (p = <0.01), flatulence, abdominal pain, greasy/pale stool and abdominal gurgling (p = <0.05). Mean dietary fat intake reduced from 62.3 g of fat before dietary intervention to 42.2 g of fat after intervention (p = <0.01). There was no statistically significant change in dietary fibre intake.

Conclusion

The use of low fat dietary interventions in patients with a SeHCAT scan <20% leads to clinically important improvement in GI symptoms and should be widely used.

Disclosure of Interest

None Declared.

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