TY - JOUR

T1 - Author Response to Letter to the Editor regarding “the Epidemiology of Bile Acid Diarrhea in Denmark” [Response to Letter]

AU - Ellegaard, Anne Marie

AU - Kårhus, Martin L.

AU - Knop, Filip K.

AU - Kårhus, Line L.

PY - 2024

Y1 - 2024

N2 - We thank Dr. Fikri for her insightful letter concerning our recent publication and appreciate her recognition of the significance of our findings.1 As Dr. Fikri underscores, our study identifies individuals with bile acid diarrhea (BAD) in Danish nationwide registries, either by the international classification of disease version 10 (ICD10) code K90.8 or a referral to a diagnostic 75selenium homotaurocholic acid (SeHCAT) test followed by a prescription of a bile acid sequestrant within 365 days. Dr. Fikri notes that this definition excludes individuals suffering from BAD but not diagnosed with SeHCAT test or not treated with bile acid sequestrants and suggests that including clinical data such as the SeHCAT test results would include more individuals suffering from BAD. Our study aimed to identify a population of individuals suffering from BAD, and not to include everyone with BAD as misdiagnosed or undiagnosed individuals would be impossible to identify in the registries. Furthermore, the design of the Danish registries precludes retrieving SeHCAT test results, which, currently, only can be retrieved by manual extraction from each individual’s patient file. For these reasons, we decided defining a population of individuals with a very high probability of a BAD diagnosis well aware that we might not include all individuals suffering from BAD. Dr. Fikri raises concerns about the ICD10 code K90.8, which was introduced in 2021. We agree with the limited use of this ICD10 code, which is why we added the extended definition of BAD discussed above. Addressing the true prevalence of BAD in the Danish population is an interesting study, but not one that is feasible by register-based research.

AB - We thank Dr. Fikri for her insightful letter concerning our recent publication and appreciate her recognition of the significance of our findings.1 As Dr. Fikri underscores, our study identifies individuals with bile acid diarrhea (BAD) in Danish nationwide registries, either by the international classification of disease version 10 (ICD10) code K90.8 or a referral to a diagnostic 75selenium homotaurocholic acid (SeHCAT) test followed by a prescription of a bile acid sequestrant within 365 days. Dr. Fikri notes that this definition excludes individuals suffering from BAD but not diagnosed with SeHCAT test or not treated with bile acid sequestrants and suggests that including clinical data such as the SeHCAT test results would include more individuals suffering from BAD. Our study aimed to identify a population of individuals suffering from BAD, and not to include everyone with BAD as misdiagnosed or undiagnosed individuals would be impossible to identify in the registries. Furthermore, the design of the Danish registries precludes retrieving SeHCAT test results, which, currently, only can be retrieved by manual extraction from each individual’s patient file. For these reasons, we decided defining a population of individuals with a very high probability of a BAD diagnosis well aware that we might not include all individuals suffering from BAD. Dr. Fikri raises concerns about the ICD10 code K90.8, which was introduced in 2021. We agree with the limited use of this ICD10 code, which is why we added the extended definition of BAD discussed above. Addressing the true prevalence of BAD in the Danish population is an interesting study, but not one that is feasible by register-based research.

U2 - 10.2147/CLEP.S455103

DO - 10.2147/CLEP.S455103

M3 - Letter

C2 - 38250454

AN - SCOPUS:85183405576

VL - 16

SP - 5

EP - 6

JO - Clinical Epidemiology

JF - Clinical Epidemiology

SN - 1179-1349

ER -