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Table 1 Characteristics and main findings of included articles. Se - sensitivity, Sp – Specificity

From: Methods for diagnosing bile acid malabsorption: a systematic review

Author, (year), referenceCountryStudy designNumber of patients /femalesStudy populationMethod used to identify BAMSeSpMain findings
Vijayvargiya. P, 2019 [14]USARetrospective case-control studyn = 124(109)IBS-D,
IBS-C and healthy volunteers
Total fecal 48-h BA in combination with primary fecal BAs49%91%Primary BAs > 10% identified patients with increased fecal weight (sensitivity 49% and specificity 91%) and rapid colonic transit (sensitivity 48% and specificity 87%
Vijayvargiya. P, 2019 [15]USARetrospective case-control studyn = 220(171)HV, IBS-D and IBS-CFecal bile acids and fecal fat76%72%Reduced total and primary fecal bile acids and increased fecal lithocholic acid were significant predictors of decreased fecal weight, frequency and consistency.
Battat R., 2019 [16]USAProspectively cross-sectional studyn = 78 (47)Crohn’s disease (CD) - IR, NR-CD and UCC490%84%A cutoff concentration of C4 of 48.3 ng/mL or greater identified patients with diarrhea attributable to BAM with 90.9% sensitivity, 84.4% specificity
Donato L., 2018 [17]USAProspectively cross-sectional studyn = 184 (110)IBS-C, IBS-D, Healthy subjectsC482%53%Higher levels of C4 was found in patients with BAM compared to those without BAM with sensitivity/specificity of 82%/53%.
Vijayvargiya P., 2017 [18]USAProspectively cross-sectional studyn = 101 (n = 83)IBS-DC4 and FGF1950%65%Data demonstrated a higher specificity (83%) with a higher cut-off of 52.5 ng/mL.
Camilleri M., 2014 [19]USAProspectively cross-sectional studyn = 124 (111)IBS-D, IBS-C and HSTotal fecal 48-h BA in combination with primary fecal Bas75%75%Estimated the specificity of the individual traits or models at 60% sensitivity for discriminating between the groups, with specificity ranging from 75% for IBS-D versus health, to 90% for IBS-D versus IBS-C
Pattni S., 2013 [11]UKProspectively cross-sectional studyn = 72 (47)Chronic diarrhoea of unknown aetiologyFGF19 compare to SeHCAT67%77%NPV and PPV of FGF19 ≤ 145 pg/mL for a SeHCAT < 10% were 82 and 61%. Data suggest that FGF19 could predict response to sequestrant therapy
Pattni S., 2012 [20]UKProspectively cross-sectional studyn = 258 (180)patients with chronic diarrheaFGF-19
+
C4
58%
74%
79%
72%
The sensitivity and specificity of FGF19 at 145 pg/ml for detecting a C4 level > 28 ng/ml were 58 and 79%, respectively. For C4 > 60 ng/ml, these were 74 and 72%;
Brydon WG., 2011 [21]ScotlandProspectively cross-sectional studyn = 196 (108)Patients with unexplained diarrheaC4 BAM type 1
C4 BAM type 2
compare to
SeHCAT
97%
90%
74%
77%
ROC analysis yielded a sensitivity/specificity of 90%/77% for type 1 BAM (ileal disease/resection) and 97%/74% for type 2 BAM
(idiopathic) using 30 ng/mL as the upper limit of normal for serum C4
Lenicek M., 2011 [22]Czech RepublicProspectively cross-sectional studyn = 466 (267)Crohn’s disease, Ilear Crohn’s resection and Healthy SubjectsFGF19 and C480%68%FGF19 levels maximizing precision was set to < 60 ng/L. In
this case, the sensitivity and specificity of FGF19 as a marker
of BAM reached 80 and 68%. BAM was also present in a substantial number of the patients with CD
Sauter GH, 1999 [23]GermanyProspective cross-sectional studyn = 129 (68)HS + chronic diarrhea of unknown originC4
Compare to
SeHCAT
90%79%75SeHCAT test yielded the same results in 19/23 (83%) patients. BAM was identified by an increase of C4 in serum with a sensitivity of 90% and a specificity of 79%.
Brydon WG, 1996 [24]UKProspective case-control studyn = 164 (108)chronic diarrhoea investigated prospectivelyC4
Compare to
SeHCAT
NPV 74%
100%
PPV 94%
96%
The positive predictive value of serum C4 was 74%. The high negative predictive value (98%) of serum c4
Balzer K, 1993 [25]GermanyProspective case-control studyn = 64HS and patients with ileal disease or resectionSeHCAT80%96%75SeHCAT retention test: sensitivity 80%, specificity 98%, accuracy 89%
Scheurlen C, 1988 [26]GermanyProspective case-control studyn = 64Crohn’s diseaseSeHCAT59.6%100%At a specificity of 100% the sensitivity of the SeHCAT test was 59.6% and the efficiency was 67.2%.
Sciarretta G, 1987, [27]ItalyProspective case-control studyn = 46 (26)healthy volunteers, distal ileum resection, Crohn’s and chronic diarrheaSeHCAT100%94%SeHCAT found to be the most suitable for differentiating between the groups, giving the 75SeHCAT test a 94% sensitivity and a 100% specificity. The data show that this test is a valid indicator of bile acid loss.
Merrick MV, 1985 [28]UKProspective case-control studyn = 42IBS and Ileal resectionSeHCAT97%80–99%The diagnosis was established by measuring the proportion of SeHCAT, a synthetic bile salt, retained 1 week after oral administration of a tracer dose of less than 100F/kg of the compound labelled with 40 kBq (1. Ci) of selenium-75.