Bile acid Malabsorption

Question 1

What is it?

Answer 1

Condition characterised by excessive bile acids in the colon, leading to chronic diarrhoea and other GI symptoms

Question 2

What are the causes?

Answer 2

Primary (type 1)- often idiopathic
Secondary (type 2)- IBD/coeliac/ileal resection or cholecystectomy
Type 3 BAM- due to other GI disorders e.g. IBS

Question 3

What are the clinical features?

Answer 3

Chronic watery diarrhoea
Often urgency and incontinence
Can get bloating, abdo pain and steatorrhoea

Nutritional deficiencies- in fat soluble vitamins due to impaired absorption (Vitamin A, D, E, K)

Question 4

What investigations are required?

Answer 4

SeHCAT
- gold standard
- nuclear medicine test to measure bile acid retention

Question 5

What is the management?

Answer 5

Bile acid sequestrants e.g. cholestyramine to bind bile and reduce diarrhoea
Low fat diet