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What is Bile Salt test? 

Bile salts are a major component of bile - a greenish-yellow fluid secreted by the liver. They are released into the small intestine along with the other bile constituents to facilitate digestion. Once they have performed their function, most of the bile salts are sent back to the liver. However, in a few liver disorders, this transport of bile salts is disrupted. In such conditions, bile salts are retained in the liver instead of being secreted into the small intestine. The liver then excretes these retained bile salts into the blood or urine. Therefore, if a patient displays symptoms of a liver disorder, the doctor may order tests to check for the presence of bile salts in both these body fluids.

Another bile salt test called the SeHCAT scan is performed to check how well your body is absorbing bile salts and if you have a condition called bile salt malabsorption, also referred to as bile acid malabsorption. This condition occurs when the area in the small intestine that absorbs the bile salts back into the body is damaged. If your body does not take up bile salts properly, you may get diarrhoea.

(Read more: Bile pigment test)

  1. Why is a Bile Salt test performed?
  2. How do you prepare for Bile Salt test?
  3. How is a Bile Salt test performed?
  4. What do Bile Salt test results mean?

A bile salt test is generally done as part of liver function test. Your doctor may order this test if you have symptoms associated with disorders of the small intestine. These include:

  • Diarrhoea with an unknown cause
  • Abdominal pain
  • Weight loss
  • Nutritional deficiencies
  • Smelly and greasy stools

The test may also be ordered in pregnant ladies to diagnose a condition called intrahepatic cholestasis of pregnancy. In this condition, a woman's liver stops releasing bile and she experiences symptoms such as itchy palms and feet and jaundice.

For a urine test, you would not need any special preparation. A laboratory technician or nurse will explain the procedure to you before you go for the test. 

For the SeHCAT scan, you may be asked to fast overnight and stop any antibiotic treatment one month before the scan. Tell your doctor if you are taking any prescription or non-prescription medicines, especially drugs like cholestyramine, colesevelam, and cisapride. He/she may modulate the dose of some of these medicines. Please do not change the course of any medicine on your own. 

Women should inform their doctor if they are pregnant or is breast-feeding.

Urine test:

Bile salt urine test is done on a random urine sample, collected any time of the day. You will be provided with a special container to collect the sample. Here is how you can collect the sample:

  • Clean your hands and genital area properly before collecting the sample. This would help prevent contamination of the sample.
  • Start urinating in the bowl. Do not collect the first few drops of urine.
  • Then, put the container under the stream of urine and collect the sample until the mark on the container - the mark will tell you just how much urine is needed for the test. 
  • Do not collect the last few drops of urine.
  • Cover the sample properly and immediately send it to the laboratory for analysis. 

SeHCAT scan:

For the SeHCAT scan, the technician will give you a capsule to swallow along with water. The capsule contains one of the bile salts called selenium homotaurocholate. A few hours later, a scan will be done to check the functioning of your intestines. You will be asked to return to the testing facility after one week to repeat the scan. The laboratory technician will then be able to estimate how much of the bile salt from the capsule is actually retained in your body. 

SeHCAT scan will involve some amount of radiation, though, the amount of radiation will be very less to affect you. It is nearly equivalent to the background radiation present in nature.

The capsule too will not cause harm either. If you are concerned about the procedure, please speak to your doctor.

Normal results:

Normal results in bile salt urine test are reported as negative. It means that bile salts are not present in the given urine sample. A numerical value may also be given in some places. A value ≤ 10 µmol/L (micromoles per litre) is considered normal. Any value above this number can be associated with an underlying condition.

The results of the SeHCAT scan are given in terms of percentage. After one week of taking the capsule, the technician will repeat the scan to check how much of the bile salt is retained by the body. Ideally, since the body recycles the bile salts it produces, the contents of the capsule should also be retained in the body. Hence, retention of 15% and above is considered normal.

Abnormal results:

In a bile salts urine test, an abnormal result is reported as positive. Sometimes, the value denoting the amount of bile salts in the urine may also be reported. Any value above 10 µmol/L can be considered abnormal. It could be indicative of the following conditions:

  • Obstructive jaundice: This means that bile salts are not able to leave the liver through regular routes, and therefore show up in the urine via blood.
  • Other liver disorders associated with jaundice.
  • In a pregnant woman, an abnormal result is suggestive of intrahepatic cholestasis of pregnancy. Bile salts above the normal range could increase the risk of preterm labour. It may also lead to breathing problems in the baby; however, the risk is very low if the condition is treated.

In a SeHCAT scan, retention of less than 15% is considered abnormal. It means that there is an excessive loss of bile salts; it could be due to bile acid malabsorption. Please speak to your doctor to know what the results precisely mean for you.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

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References

  1. Chapter 13, Assessment of hepatic function and investigation of jaundice In: Marshal W.J, Lapsley M, Day A.P, Ayling R.M. Clinical biochemistry: Metabolic and clinical aspects. 3rd ed. Churchill Livingstone: Elsevier; 2014. p.232—245.
  2. Bathena SPR, Thakare R, Gautam N, Mukherjee S, Olivera M, Meza J, Alnouti Y. Urinary Bile Acids as Biomarkers for Liver Diseases I. Stability of the Baseline Profile in Healthy Subjects. Toxicological Sciences. February 2015, 143(2):296–307. PMID: 25344562
  3. University Hospitals Coventry and Warwickshire [Internet]. NHS Foundation Trust. National Health Service. U.K. What is Bam?
  4. Genetics Home Reference [internet]. National Institute of Health: US National Library of Medicine. US Department of Health and Human Services; Intrahepatic cholestasis of pregnancy
  5. Chapter 7, Gastroenterology In: Provan D. Oxford Handbook of Clinical and Laboratory Investigation. 4th ed. United Kingdom: Oxford University Press; 2018. p.519.
  6. The Hillingdon Hospitals [Internet]. NHS Foundation Trust. National Health Service. U.K. Nuclear Medicine SeHCAT Scan