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
619919Useful 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
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 |
Reject Due To
Thawing | Serum: Cold OK; Warm reject Feces: Cold reject; Warm reject |
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 daysSpecimen Retention Time
Serum: 14 days; Stool: 7 daysPerforming Laboratory
Mayo Clinic Laboratories in RochesterCPT 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.