Bile acid malabsorption

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Obesity, Sleep & Internal medicine
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Bile acid malabsorption
Synonyms	Bile acid diarrhea, BAM
Pronounce	N/A
Specialty	Gastroenterology
Symptoms	Chronic diarrhea, abdominal pain, bloating
Complications	Dehydration, electrolyte imbalance
Onset	Any age
Duration	Chronic
Types	N/A
Causes	Ileal resection, Crohn's disease, idiopathic
Risks	Ileal disease, cholecystectomy
Diagnosis	SeHCAT scan, fecal bile acid test
Differential diagnosis	Irritable bowel syndrome, celiac disease
Prevention	N/A
Treatment	Bile acid sequestrants (e.g., cholestyramine)
Medication	Cholestyramine, colesevelam, colestipol
Prognosis	Good with treatment
Frequency	Common in patients with ileal resection
Deaths	N/A

Bile Acid Malabsorption (BAM), also referred to as bile acid diarrhea, is a condition that primarily results in chronic diarrhea. It has several synonyms, including bile acid-induced diarrhea, cholerheic or choleretic enteropathy, and bile salt diarrhea or malabsorption.

Introduction

BAM is characterized by the body’s inability to properly absorb bile acids in the terminal ileum, which can lead to a range of gastrointestinal symptoms, with chronic diarrhea being the most prevalent.

Pathophysiology

Bile Acid Physiology

Bile acids are crucial for the digestion and absorption of fats and fat-soluble vitamins in the small intestine. The liver produces bile, which is then stored in the gallbladder and released into the small intestine.

Bile acid molecular structure.

Mechanism of Malabsorption

In cases of BAM, bile acids are not sufficiently absorbed and instead enter the colon, which leads to water and electrolyte secretion and, consequently, diarrhea.

Causes

Secondary BAM

Secondary BAM can result from conditions that affect the ileum, such as Crohn's disease, Celiac disease, or surgical resections.

Primary BAM

Primary BAM, on the other hand, may be due to an overproduction of bile acids by the liver, unrelated to any distinct pathology of the ileum.

Clinical Presentation

Patients typically present with chronic watery diarrhea, which may be accompanied by abdominal pain, bloating, and urgency. These symptoms significantly impact the quality of life.

Diagnosis

The diagnosis is often made using a combination of clinical assessment, fecal bile acid tests, and sometimes SeHCAT scanning, which assesses bile acid malabsorption.

Treatment

Bile Acid Sequestrants

Bile acid sequestrants, such as Cholestyramine, Colestipol, and Colesevelam, are often effective in treating BAM. They work by binding bile acids in the gastrointestinal tract, thereby preventing them from causing diarrhea.

Medications such as bile acid sequestrants are used in the treatment of BAM.

Prognosis

With appropriate management, many patients with BAM can achieve significant symptom relief and improvement in their quality of life.

See Also

• Diarrhea
• Gastroenterology
• Digestive system
• Liver diseases
• Bile

External Links

• Mayo Clinic - Bile Reflux and BAM
• NCBI - Bile Acid Malabsorption in Clinical Practice

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