So it’s official, I am suffering with bile
salt malabsorbtion. The results of my recent SeHCAT scans have shown this to be
the case. However I am lucky enough not to be suffering from the usual side
effects experienced by most people (chronic diarrhoea) and instead it has
manifested itself in my low vitamin B12 count.
The SeHCAT scan is the easiest and most
reliable way to diagnose bile acidic malabsorbtion and is done in two parts. It
measures the multiple cycles of bile acid excretion and reabsorbtion. Bile acid
(salts) are produced in the liver and enter the biliary system where they are
stored in the gall bladder (mine was removed during my first cytoreductive
surgery) and are released after meals where they play an important role in the
digestion and absorption of fats in the small intestine. Then, around 95% of
the bile acid is reabsorbed by the ilium (which was affected in my initial
appendectomy/peritonitis) and the liver (Liver capsulectomy during initial
cytoreductive surgery) where they are then re-secreted. This usually happens
between 4-6 times a day.
There are three classifications of types of
bile salt malabsorbtion-
Type
1- Bile acidic malabsorbtion related to ileal
resection or inflammation (found in Crohn’s).
Type
2- Idiopathic bile acid malabsorbtion, Primary bile
acid diarrhoea.
Type
3- Secondary to various gastrointestinal diseases
including (chlolecystectomy).
At
the first scan I attended the nuclear medicine department at Bristol’s
Southmead hospital and was initially given a radioactive pill to swallow some
two hours before the scan itself. Next came the scan itself. The scanner is
slightly different to a CT scanner in appearance in that once on the “bed” the
patient is positioned between large “plates” both above and below the bed. You
then have to lie still for a ten minute period where the level of radio
activity hitting these “plates” is recorded. And that’s it!
The scan is then repeated seven days later
where the radioactivity level is again recorded and the amount of reabsorbancy
can be calculated. Retention at 7 days should be above 15% values below 15% are
considered mild, below 10% moderate and below 5 % severe. Not sure where I lie
on this scale as yet!
Due to my lack of symptoms other than the
B12 deficiency which is being treated with supplementary injections every 12
weeks there is no need for any further treatment. However the side effects of
bile acidic malabsorbancy can be treated with medication if required.
So for me it’s good news, the reason for my
vitamin B12 deficiency has been diagnosed and we now know that bile salt
malabsorbancy is present. Something to keep an eye on. But for now I am lucky
that I don’t have any other side effects. I am fit and well, feeling better
that I have done in a long time now that the B12 jabs are working. I’m back
running longer distances (up to 10miles) on a Sunday morning and back caving
regularly. Right now life is good!
