Thor Halfdanarson, Professor of Oncology at Mayo Clinic School of Medicine, shared on X:
“Bile acid diarrhea (BAD) and bile acid malabsorption (BAM) are common among patients with neuroendocrine tumors and diarrhea. One study (Khanna et al. PMID: 34365537) reported that among NET patients with diarrhea, >90% had BAM present (not necessarily the sole cause of the diarrhea) and the length of ileal resection did not matter. Surprisingly, BAM was very common among patients with no prior ileal resection.
BAM is challenging to diagnose but with the availability of theavailable at Mayo Laboratories, it is getting easier (link in comments). It this study, led by Dr. Michael Camilleri of Gastroenterology at Mayo Clinic, BAM was present in 60% of patients with NETs and diarrhea as assessed with the BAMRP, lower than the previously reported >90% but that was documented by different methodology, 48-hr stool collection which is understandably unpopular among all involved.
The other method often quoted, the SeHCAT, is not available in the US. Many patients in this study had coexisting elevation of plasma 5HIAA suggesting concurrent carcinoid syndrome but others did not.
Bottom line:
- BAM is common in patients with NETs and diarrhea
- It often coexists with carcinoid syndrome (and exocrine pancreatic insufficiency from SSAs and/or pancreatic resections)
- It can occur as the sole cause of diarrhea, often in patients with no prior ileal resections
- It is much easier to diagnose now, thanks to the BAMRP panel but maybe not quite as sensitive
- BAM/BAD is highly responsive to bile-acid binding drugs like colestipol
- Diagnosing and treating BAM/BAD can drastically improve the QOL of patients with NETs and diarrhea.”
Title: Bile Acid Malabsorption Panel in Patients with Treated Neuroendocrine Tumors
Authors: Ayah Matar, Thorvardur R. Halfdanarson, Mohamad B. Sonbol, Timothy J. Hobday, Patrick W. McGarrah, Morgan C. Miller, Rachel A. Eiring, Leslie J. Donato, Michael Camilleri
Read the Full Article.
Other articles featuring Thor Halfdanarson on OncoDaily.