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Test 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.


Secondary ID

619919

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)

Specimen Type

Fecal
Serum

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

Reject Due To

Thawing Serum: Cold OK; Warm reject
Feces: Cold reject; Warm reject
  All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

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.

Method Description

Fractionated fecal bile acids are quantified in a random fecal collection. Samples are analyzed on a tandem mass spectrometer.(Unpublished Mayo method)

 

7Alpha-hydroxy-cholesten-3-one (7aC4) is extracted from the sample. After addition of a deuterium-labeled 7aC4 internal standard, 7aC4 is measured by liquid chromatography tandem mass spectrometry.(Donato LJ, Lueke A, Kenyon SM, Meeusen JW, Camilleri M. Description of analytical method and clinical utility of measuring serum 7-alpha-hydroxy-4-cholesten-3-one (7aC4) by mass spectrometry. Clin Biochem. 2018;52:106-111)

Day(s) Performed

Wednesday

Report Available

2 to 9 days

Specimen Retention Time

Serum: 14 days; Stool: 7 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

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.