Friday, 3 April 2015
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!