Clin Med
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Bile acid malabsorption (BAM) is never life threatening but can cause chronic symptoms. A survey of senior British gastroenterologists was conducted to examine their approach to patients with potential BAM. Of the 706 gastroenterologists contacted, 62% replied. ⋯ Sixty-one per cent of patients are diagnosed with type 1 BAM (secondary to terminal ileal disease), 22% have type 2 (idiopathic bile acid malabsorption) and 15% type 3 (unrelated to terminal ileal disease). Only one third of gastroenterologists use a definitive diagnostic test for BAM. BAM (particularly type 2) is under-diagnosed because it is frequently not considered and even when considered, many patients are not subjected to definitive diagnostic testing.
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Hypertrophic cardiomyopalthy can occur at any age, not just in younger patients. An electrocardiogram showing voltage criteria for left ventricular hypertrophy with prominent ST changes and deep T wave inversion should alert the clinician to this possibility Echocardiograpghy will make the diagnosis in the majority of patients.