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The Epidemiology of Bile Acid Diarrhea in Denmark [Letter]

Authors Fikri E 

Received 9 December 2023

Accepted for publication 13 December 2023

Published 15 December 2023 Volume 2023:15 Pages 1225—1226


Checked for plagiarism Yes

Editor who approved publication: Professor Vera Ehrenstein

Elanda Fikri1,2

1Department of Environmental Health, Poltekkes Kemenkes Bandung, Bandung, Indonesia; 2Center of Excellence on Utilization of Local Material for Health Improvement, Bandung Health Polytechnic, Bandung, Indonesia

Correspondence: Elanda Fikri, Department of Environmental Health, Poltekkes Kemenkes Bandung, Jl.Pajajaran 56, Bandung, Jawa Barat, Indonesia, Email [email protected]

View the original paper by Dr Kårhus and colleagues

A Response to Letter has been published for this article.

Dear editor

We were very impressed with the article entitled “The Epidemiology of Bile Acid Diarrhea in Denmark”. The results of this research have advantages, namely: 1) Identify individuals with bile acid diarrhea (BAD) in Denmark using data from the national registry, 2) Identify individuals suffering from BAD based on ICD10 diagnosis codes or SeHCAT test followed by prescription of bile acid binders within a period of 365 days, 3) Show differences in the frequency of BAD diagnosis in different regions of Denmark, 4) Provide information on the characteristics of individuals suffering from BAD, including lower education level, lower income, and higher number of contacts with health services compared to a comparable control group, 5) Track the use of liraglutide as a potential therapy for BAD.1

However, we have also discovered several limitations that need to be corrected in the future, namely: 1) The use of a combination of SeHCAT testing and prescription of bile acid binders over a 365-day period to identify individuals with BAD may not include the entire population who actually have BAD. Some individuals with BAD may not have undergone the SeHCAT test or received alternative treatment, so they will not be identified in this study, 2) The ICD10 diagnosis codes for BAD will only be used starting in 2021, so the validity and consistency of using these codes prior to that year is limited, 3) Although the study tracked the use of liraglutide as a potential therapy for BAD, it did not provide information on the effectiveness or safety of liraglutide in the treatment of BAD, 4) The study findings cannot be directly generalized to populations outside Denmark due to differences in health systems, clinical practices, and population characteristics.

To obtain better results, we recommend that further research be carried out by 1) Further validate the definition of BAD used in this study by comparing it with SeHCAT test results and other clinical data to ensure that it covers the entire population with BAD, 2) Conduct prospective studies involving direct data collection from individuals with BAD, including information on symptoms, diagnostic test results, response to treatment, and quality of life, to gain a more in-depth understanding of the characteristics and experiences of individuals with BAD,2 3) Conduct further analysis of risk factors associated with BAD, including the relationship with other comorbid conditions, including associations with other comorbid conditions, genetic factors, and environmental factors, to better understand the pathophysiology and epidemiology of BAD,3 4) Conduct comparative studies comparing the effectiveness and safety of various therapies for BAD, including bile acid binders and other therapies such as liraglutide, to help guide optimal treatment options.


There is no conflict of interest related to this communication.


1. Kårhus ML, Ellegaard AM, Winther-Jensen M, Hansen S, Knop FK, Kårhus LL. The epidemiology of bile acid Diarrhea in Denmark. Clin Epidemiol. 2023;15:1173–1181. doi:10.2147/CLEP.S442054

2. BouSaba J, Sannaa W, McKinzie S, et al. Impact of bile acid diarrhea in patients with diarrhea-predominant irritable bowel syndrome on symptoms and quality of life. Clin Gastroenterol Hepatol. 2022;20(9):2083–2090. doi:10.1016/j.cgh.2021.11.035

3. Farrugia A, Arasaradnam R. Bile acid diarrhoea: pathophysiology, diagnosis and management. Frontline Gastroenterol. 2020;12(6):500–507. doi:10.1136/flgastro-2020-101436

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