Bile Acid Malabsorption

Aka: Bile Acid Malabsorption

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II. Pathophysiology

  1. Terminal ileum fails to reabsorb bile acids
  2. Results in Secretory Diarrhea (Chronic Watery Diarrhea)

III. Associated Conditions

  1. Irritable Bowel Syndrome
    1. One third malabsorb bile acids
  2. Microscopic Colitis
    1. One third malabsorb bile acids
  3. Crohn Disease Diarrhea
  4. Post-CholecystectomyDiarrhea

IV. Labs: Experimental

  1. Serum 7a-hydroxy-4-cholesten-3-one
    1. Increased in Bile Acid Malabsorption
  2. Fibroblast growth factor 19
    1. Decreased in Bile Acid Malabsorption

V. Imaging: Not available in U.S.

  1. Selenium homocholic acid taurocholate scanning (SeHCAT)
    1. Radionuclide tracer used in whole body gamma imaging (Not FDA approved in U.S.)

VI. Management

  1. Bile Binding Resin
    1. Cholestyramine (Questran)
    2. Colestipol (Colestid)
    3. Colesevelam (Welchol)

VII. References

  1. Walters (2010) Therap Adv Gastroenterol 3(6): 349–357 [PubMed]

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