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Acute GVHD often involves the lower gastrointestinal (GI) tract, inducing diarrhoea, weight loss and abdominal pain. Allogeneic immune cells and the conditioning regimen combine to damage http://www.selleckchem.com/products/PD-0325901.html the GI tract leading to inflammation of the mucosa (Hill et?al, 1997). Many patients, particularly those with lower GI GVHD, do not respond to intensive immunosuppression (MacMillan et?al, 2002). This may be because the process of inflammation is not effectively suppressed by the agents used. Alternatively, additional mechanisms may be at play. Upper and lower GI endoscopy with biopsy are standard investigations of GI GVHD. However many patients have clinical symptoms discordant with the findings from these investigations. In one study, 25% of patients with clinical Glucksberg stage 2�C4 GI GVHD had both endoscopic and histological grades http://www.selleck.cn/products/JNJ-26481585.html patients may be due to mechanisms other than colitis. One important function of the small bowel is to re-absorb bile acids as part of the enterohepatic circulation. Bile acids are re-absorbed by specific bile acid transporters in the terminal ileum. If this process is disrupted (e.g. by damage to the terminal ileum through Crohn��s disease or surgery) bile acids reach the colon in increased amounts where they cause watery diarrhoea (and abdominal pain) by inducing secretion of sodium and water (Pattni & Walters, 2009). Bile acid malabsorption is investigated using a selenium-75-homocholic acid taurine (SeHCAT) scan in which the radiolabelled bile acid is given orally and the whole body retention is measured at 7?days (Williams et?al, 1991; Ford et?al, 1992). Treatment with bile acid sequestrants is effective in the http://www.selleckchem.com/products/epz-6438.html majority of cases (Wedlake et?al, 2009). Here we report retrospective observational data that suggest that the diarrhoea in GI GVHD may be related to bile acid malabsorption in some patients. We have retrospectively reviewed data from all patients undergoing allogeneic transplantation at St Bartholomew��s Hospital who underwent SeHCAT scans for investigation of persistent diarrhoea in the context of GI GVHD between 2003 and 2011. Retention of