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P307. A survey of patient opinion regarding the tolerability of, adherence to and efficacy of colesevelam compared with cholestyramine in the treatment of diarrhoea following ileal resection in Crohn's disease

M. Robinson1, C.A. Lamb2, F.G. Bergin1, J.C. Mansfield1

1Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; 2University of Newcastle, Newcastle upon Tyne, United Kingdom

Aim: Diarrhoea due to bile acid malabsorption is common following ileal resection in Crohn's disease. In this situation patients may find symptomatic benefit from the use of bile acid sequestrants. Historically in our hospital cholestyramine sachets (Questran) have been used first line to treat bile acid malabsorption in post-operative disease. Due to a recent manufacturing problem with cholestyramine, a number of patients have been switched to colesevelam (Cholestagel), a capsule based sequestrant. This is an unlicensed indication for colesevelam. This service development patient survey aimed to investigate patient opinion of tolerability, adherence to, and efficacy of colesevelam in treating diarrhoea due to bile acid malabsorption.

Methods: Patients with Crohn's disease attending the inflammatory bowel disease clinic, that had previously received cholestyramine and were now receiving colesevelam for diarrhoea following ileal resection, were asked to complete a short survey.

Results:

  • A total of ten patients had previously taken cholestyramine and were now taking colesevelam.
  • Nine patients said they did not find cholestyramine easy to take.
  • Nine patients felt colesevelam was easier to take than cholestyramine. The remaining one patient felt colesevelam was no easier to take and had not found cholestyramine easy to take.
  • All the patients who found colesevelam easier to take than cholestyramine felt their adherence to therapy was consequently improved whilst taking colesevelam.
  • Only six of the ten patients felt cholestyramine helped their diarrhoea whereas nine of ten felt colesevelam helped their diarrhoea. The remaining one patient felt colesevelam sometimes helped their diarrhoea but that cholestyramine did not.

Conclusion: According to this small survey, patients find colesevelam easier to take, and experience improved concordance with therapy when compared to taking cholestyramine for diarrhoea associated with bile acid malabsorption in post-operative Crohn's disease. More patients experienced an improvement in symptoms of diarrhoea whilst taking colesevelam compared to cholestyramine. The results of this patient survey would support the development of a head to head trial of colesevelam versus cholestyramine as a treatment for diarrhoea in post-operative Crohn's disease.