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HelpTest Code BAMRP Bile Acids Malabsorption Panel, Serum and Feces
Ordering Guidance
This test is for evaluation of bowel dysfunction.
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.
For confirmatory testing for bile acid malabsorption using a 48-hour fecal collection, order BA48F / Bile Acids, Bowel Dysfunction, 48 Hour, Feces
Shipping Instructions
Feces and serum should be shipped together. Specimens shipped separately may delay testing.
Specimen Required
Patient Preparation:
1. For serum collection: Patient must fast for at least 12 hours prior to collection; fasting morning specimen is preferred.
2. Patient should not have recently taken antibiotics, bile acid sequestrants for 24 hours prior to collection, or statins for 5 days prior to collection.
3. No laxatives (particularly mineral oil and castor oil)
4. No synthetic fat substitutes (eg, Olestra) or fat-blocking nutritional supplements
5. Barium interferes with test procedure; if patient has used barium, it is recommended to wait 48 hours before starting the stool collection.
Both feces and serum are required.
Collection for both serum and feces should be completed on the same day, but up to 3 days apart is acceptable.
Specimen Type: Serum
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. Centrifuge and aliquot 1 mL of serum into a plastic vial.
2. Send specimen frozen.
Specimen Type: Feces
Supplies: Stool Container, Small (Random), 4 oz (T288)
Container/Tube: Fecal container
Specimen Volume: 5 g
Collection Instructions:
1. Collect a loose, unpreserved, random fecal specimen.
2. Freeze immediately.
Additional Information: If additional tests are ordered, aliquot and separate sample prior to freezing to allow 1 container per test.
Useful For
Aiding in the evaluation of patients suspected of having chronic diarrhea symptoms due to bile acid malabsorption
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| 7AC4 | 7AC4, Bile Acid Synthesis, S | Yes | Yes |
| BAMRF | Bile Acid, Malabsorption, F | No | Yes |
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Bile Acid Malabsorption PanelSpecimen Type
FecalSerum
Specimen Minimum Volume
Feces: See Specimen Collection
Homogenized feces: 1 mL
Serum: 0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Fecal | Frozen | 30 days | |
| Serum | Frozen (preferred) | 90 days | |
| Refrigerated | 72 hours | ||
| Ambient | 24 hours |
Reference Values
BILE ACID MALABSORPTION, FECAL:
≥18 years:
Sum of cholic acid and chenodeoxycholic acid: ≤10.0%
7AC4, BILE ACID SYNTHESIS, SERUM:
2.5-63.2 ng/mL
Reference values have not been established for patients who are younger than 18 years of age.
Interpretation
When serum 7alpha-hydroxy-4-cholesten-3-one results are above 52.5 ng/mL and primary fecal bile acid results are above 10%, this test is 66% sensitive and 95% specific for bile acid malabsorption.
Pharmacological treatment with bile acid sequestrants has been shown to improve symptoms in some patients.
Clinical Reference
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 Apr;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. Vijayvargiya P, Gonzalez Izundegui D, Calderon G, et al. Increased fecal bile acid excretion in a significant subset of patients with other inflammatory diarrheal diseases. Dig Dis Sci. 2022;67(6):2413-2419. doi:10.1007/s10620-021-06993-5
4. Vijayvargiya P, Camilleri M, Taylor A, Busciglio I, Loftus EV Jr, Donato LJ: Combined fasting serum C4 and primary bile acids from a single stool sample to diagnose bile acid diarrhea. Gastroenterology. 2020 Nov;159(5):1952-1954.e2
5. Duboc H, Rainteau D, Rajca S, et al. Increase in fecal primary bile acids and dysbiosis in patients with diarrhea-predominant irritable bowel syndrome. Neurogastroenterol Motil. 2012;24(6):513-520, e246-7
6. 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
7. Vijayvargiya P, Camilleri M, Carlson P, et al. Performance characteristics of serum C4 and FGF19 measurements to exclude the diagnosis of bile acid diarrhoea in IBS-diarrhoea and functional diarrhoea. Aliment Pharmacol Ther. 2017;46(6):581-588. doi:10.1111/apt.14214
8. Camilleri M, Nadeau A, Tremaine WJ, et al. Measurement of serum 7 alpha-hydroxy-4-cholesten-3-one (or 7AC4), a surrogate test for bile acid malabsorption in health, ileal disease and irritable bowel syndrome using liquid chromatography-tandem mass spectrometry. Neurogastroenterol Motil. 2009;21(7):734-743
9. Wong BS, Camilleri M, Carlson P, et al. Increased bile acid biosynthesis is associated with irritable bowel syndrome with diarrhea. Clin Gastroenterol Hepatol. 2012;10(9):1009-1015.e3
Day(s) Performed
Wednesday
Report Available
2 to 9 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
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
82542 x2
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| BAMRP | Bile Acid Malabsorption Panel | 104027-8 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 65504 | 7AC4, Bile Acid Synthesis, S | 94866-1 |
| 620308 | Bile Acids, % CDCA + CA, F | 103710-0 |
| 619971 | Bile Acid Malabsorption Panel Interpretation | 59462-2 |
Testing Algorithm
For more information see Bile Acid-Associated Tests Ordering Guide.
Forms
If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Test Request (T728) with the specimen.