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    SeHCAT (tauroselcholic [75 selenium] acid) for diagnosing bile acid diarrhoea

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    1 Recommendations

    1.1 There is not enough evidence to recommend routine use of SeHCAT (tauroselcholic [75 selenium] acid) for diagnosing bile acid diarrhoea in people with:

    • chronic diarrhoea with an unknown cause, suspected or diagnosed diarrhoea-predominant irritable bowel syndrome (IBS‑D) or functional diarrhoea

    • Crohn's disease without ileal resection who have chronic diarrhoea.

    1.2 Further research is recommended (see section 5) on:

    • how SeHCAT test results affect decisions about treatment and clinical outcomes

    • the tolerability and effectiveness of treatments for bile acid diarrhoea

    • the health-related quality of life of people with bile acid diarrhoea.

    1.3 Centres currently using SeHCAT for diagnosing bile acid diarrhoea should do so as part of research or further data collection (see section 5).

    Why the committee made these recommendations

    SeHCAT is a radiopharmaceutical test for diagnosing bile acid diarrhoea. It was recommended for use only in research in 2012 because of limited clinical evidence.

    Although there is now some more clinical evidence, it remains limited in quantity and quality. Most studies are small and give results only for people who had a positive SeHCAT test result. It is unclear how the test results are used to guide management of bile acid diarrhoea, and how well people tolerate treatment. So it is uncertain how having a diagnosis affects longer-term clinical outcomes.

    The limited clinical data means that the economic model includes many assumptions. The results are highly uncertain and SeHCAT's cost effectiveness cannot be determined. So, although SeHCAT shows promise, further research is needed.