The Epidemiology of Bile Acid Diarrhea in Denmark

Abstract

Objective

Bile acid diarrhea (BAD) is a socially debilitating disease with frequent bowel movements, urgency, and fecal incontinence as the main symptoms. It is caused by excessive bile acid levels in the colon and is most commonly treated with bile acid sequestrants. It is estimated that 1–2% of the population suffers from the disease, but only a fraction of these are properly diagnosed with the gold standard ⁷⁵selenium-homotaurocholic acid (SeHCAT) test. Here, we use nationwide registries to describe the demographic characteristics of individuals suffering from BAD in Denmark.

Methods

Since the International Classification of Diseases diagnosis code for BAD was not used until 2021, we identified the BAD population by referral to SeHCAT testing followed by a prescription of a bile acid sequestrant (colestyramine, colestipol or colesevelam) within 365 days. The study period was from 2003 to 2021.

Results

During the study period, a total of 5264 individuals with BAD were identified with large differences between the five regions in Denmark. The number of prescriptions of colestyramine and colesevelam, the number of SeHCAT tests, and the number of individuals diagnosed with BAD increased during the study period. The BAD population had more co-morbidities and more health care contacts as well as lower levels of education and income compared with age- and sex-matched controls from the general population.

Conclusion

Using the Danish registries, we identified a BAD population, which seems to be inferior in health care and socio-economic parameters compared with the Danish general population.

Keywords:

• Bile acid diarrhea
• epidemiology
• nationwide registries

Abbreviations

BAD, bile acid diarrhea; ICD10, the international classification of diseases version 10; SeHCAT, ⁷⁵selenium-homotaurocholic acid; ATC, the anatomical therapeutic chemical classification; ISCED, the international standard classification of education; NMI, the Nordic multimorbidity index; GLP-1, glucagon-like peptide 1.

Data Sharing Statement

The dataset supporting the conclusions of this article is based on data from Danish national health registers and restrictions apply to the availability of these data, which were accessed through Statistics Denmark’s server under license for the current study. According to Danish law, this information cannot be publicly available. A request for access to the data needs approval from appropriate Danish authorities and are subject to Danish regulations on personal data protection.

Ethics Approval Statement

The study is approved by the Danish Data Protection Agency and registered in the Capital Region’s inventory (P-2022-253). Danish law does not require informed consent for registry studies using administrative data.

Acknowledgments

We thank Janne Petersen for contributing to the conceptualization and planning of the study.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Martin L Kårhus  and  Anne-Marie Ellegaard share the first-authorship, Filip K. Knop and Line L Kårhus share the last-authorship.

Disclosure

The authors declare no conflicts of interest.