Test Id : BA48F
Bile Acids, Bowel Dysfunction, 48 Hour, Feces
Useful For
Suggests clinical disorders or settings where the test may be helpful
Aids in evaluation of patients suspected of having irritable bowel syndrome-diarrhea symptoms due to bile acid malabsorption
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For information see Bile Acid-Associated Tests Ordering Guide
Method Name
A short description of the method used to perform the test
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Fecal bile acids
Stool bile acids
Fecal bile salts
Stool bile salts
Bile acid malabsorption
Fractionated and Total Bile Acids
BA48F
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For information see Bile Acid-Associated Tests Ordering Guide
Specimen Type
Describes the specimen type validated for testing
Fecal
Ordering Guidance
This test is for evaluation of bowel dysfunction or confirmatory testing for bile acid malabsorption using a 48-hour fecal collection.
For evaluation of hepatobiliary dysfunction, order BILEA / Bile Acids, Total, Serum.
For evaluation of patients treated with urso or cholate, order BAFS / Bile Acids, Fractionated and Total, Serum.
For evaluation of inborn errors of metabolism, order BAIPD / Bile Acids for Peroxisomal Disorders, Serum.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Patient Preparation:
1. The patient should be on a fat-controlled diet (100-150 g fat per day) for 3 days before and during the collection period.
2. Patient should not use:
a. Antibiotics for 7 days before or during specimen collection
b. Statins for 5 days before or during specimen collection
c. Laxatives (particularly mineral oil and castor oil) for 3 days before or during specimen collection.
d. Bile acid sequestrants for 24 hours before or during specimen collection
e. Synthetic fat substitutes (eg, Olestra) or fat-blocking nutritional supplements for 24 hours before or during the specimen collection
3. If the patient has used barium, it is recommended to wait at least 48 hours before collecting the specimen.
Supplies: Stool Containers - 24, 48, 72 Hour Kit (T291)
Collection Container/Tube: Stool container that complies with shipping requirements
Specimen Volume: Entire 48-hour collection
Collection Instructions:
1. Do not use other containers.
2. Freeze immediately.
3. All containers must be sent together.
4. The entire collection must contain at least 5 g of feces.
5. The number of containers sent should be indicated on the labels (1 of 4, for example).
Additional Information:
1. The patient may store specimen at refrigerate temperature during the collection period, but it must be frozen immediately after completion.
2. If additional tests are ordered, aliquot and separate sample prior to freezing to allow 1 container per test.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Test Request (T728) with the specimen.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
5 g
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Fecal | Frozen | 30 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Aids in evaluation of patients suspected of having irritable bowel syndrome-diarrhea symptoms due to bile acid malabsorption
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For information see Bile Acid-Associated Tests Ordering Guide
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Bile acids are natural products of cholesterol synthesis that aid in the emulsification and absorption of dietary fats in the small intestine. The majority of bile acids are reabsorbed in the ileum of the healthy individual, with only 5% excreted in feces.(1) Primary bile acids cholic acid (CA) and chenodeoxycholic acid (CDCA) are deconjugated and dehydroxylated via intestinal bacteria into secondary bile acids deoxycholic acid (DCA) and lithocholic acid (LCA), respectively.(2) The sum of CA, CDCA, DCA, LCA, and ursodeoxycholic acid (UDCA) compose the majority of bile acids in the feces. Impaired absorption of bile acids in the terminal ileum leads to excess bile acids in the colon that can cause diarrhea from chloride and water secretion; a condition called bile acid malabsorption (BAM).
Irritable bowel syndrome (IBS) is a nonspecific multifactorial disorder involving the large intestine. IBS is characterized by cramping, bloating, diarrhea, and constipation and classified as either IBS-D (diarrhea) or IBS-C (constipation) by the Rome III criteria.(3) Up to 50% of IBS-D patients have accelerated colonic transit time; the mechanism of IBS-D pathophysiology is varied with more than 25% having BAM.(1,4)
Several methods have been developed for detection of BAM, but are not widely available in clinical practice.(5) Therefore, patients are often placed on trials of bile acids sequestrants to determine if symptoms improve.
Quantitation of fecal bile acids aids in screening for IBS-D and identification of patients with chronic diarrhea who may benefit from bile acid sequestrant therapy.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
> or = to 18 years:
Sum of cholic acid and chenodeoxycholic acid < or =9.7%
Total bile acids < or =2619 mcmoles/48 h
Reference values have not been established for patients who are younger than 18 years of age
Interpretation
Provides information to assist in interpretation of the test results
Elevated total fecal bile acid or percent cholic acid plus chenodeoxycholic acid is consistent with the diagnosis of bile acid malabsorption.
Pharmacological treatment with bile acid sequestrants has been shown to improve symptoms in some patients.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Bile acids are not stable in stool. Stool samples must be kept frozen immediately after collection.
Supportive Data
Bile acid (BA) malabsorption is suspected when total BA is greater than 2337 mcmol/48h, or primary BA (% cholic acid plus chenodeoxycholic acid) is greater than 10%, or total BA is greater than 1000 mcmol/48h + primary BA is greater or equal to 4%.(1)
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Vijayvargiya P, Camilleri M, Chedid V, et al. Analysis of fecal primary bile acids detects increased stool weight and colonic transit in patients with chronic functional diarrhea. Clin Gastroenterol Hepatol. 2019;17(5):922-929.e2
2. Vijayvargiya P, Camilleri M. Current practice in the diagnosis of bile acid diarrhea. Gastroenterology. 2019;156:(5):1233-1238
3. Wedlake L, A'Hern R, Russell D, Thomas K, Walters JR, Andreyev HJ. Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2009;30(7):707-717
4. Shin A, Camilleri M, Vijayvargiya P, et al. Bowel functions, fecal unconjugated primary and secondary bile acids, and colonic transit in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2013 Oct;11(10):1270-1275
5. Longstreth GF, Thompson WG, Chey WD, et al: Functional bowel disorders. Gastroenterology. 2006;130:1480-1491
6. Camilleri M, McKinzie S, Busciglio I, et al. Prospective study of motor, sensory, psychologic, and autonomic functions in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2008;6:772-781
7. Vijayvargiya P, Camilleri M, Shin A, Saenger A. Methods for diagnosis of bile acid malabsorption in clinical practice. Clin Gastroenterol Hepatol. 2013;11(10):1232-1239
Method Description
Describes how the test is performed and provides a method-specific reference
Fractionated fecal bile acids are quantified in a 48-hour fecal collection during which a high-fat intake diet was followed. Samples are analyzed on a tandem mass spectrometer.(Unpublished Mayo method)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Wednesday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
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Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
82542
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| BA48F | Bile Acids, Bowel Dysfunc, 48 Hr, F | 93338-2 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 36968 | Bile Acids, % CDCA + CA, F | 93337-4 |
| 36969 | Total Bile Acids, F | 93336-6 |
| 610285 | Stool Weight | 30078-0 |