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Bile Acid Malabsorption

Chronic watery diarrhea due to inadequate bile acid absorption in the terminal ileum.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Bile Acid Malabsorption?

Bile acid malabsorption (BAM) is a clinical syndrome of chronic watery diarrhea developing as a result of inadequate reabsorption of bile acids in the terminal ileum and reaching the colon. Increased bile acids in the colon stimulate water and electrolyte secretion through chloride channels, causing secretory diarrhea.

It is classified into three types: Type 1 (secondary - ileal disease, Crohn's, ileal resection), Type 2 (primary - idiopathic, often associated with FGF19 deficiency), Type 3 (secondary - cholecystectomy, IBS-D, celiac, microscopic colitis, postvagotomy).

Although it is found in 30-50% of patients diagnosed with IBS-D, the diagnosis is delayed because the SeHCAT test (gold standard) is not widely available; serum 7α-hydroxy-4-cholesten-3-one (C4) and FGF19 measurements are used as alternatives. Empirical treatment with cholestyramine is often performed.

Symptoms

Chronic watery non-bloody diarrhea (3-10 stools/day)
Postprandial urgency
Nocturnal diarrhea
Yellow-green oily stool
Mild abdominal cramps
Bloating, flatulence
Mild weight loss
Fecal incontinence
Itching (postcholecystectomy)

Risk Factors

Terminal ileum disease (Crohn's, tuberculosis, lymphoma)
Ileal resection (>100 cm)
Cholecystectomy
IBS-D diagnosis (33% have BAM)
Pelvic radiotherapy
Celiac disease
Microscopic colitis
Vagotomy, gastrectomy
Chronic pancreatitis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Watery diarrhea lasting more than 4 weeks
  • Diarrhea unresponsive to dietary measures
  • Postcholecystectomy persistent diarrhea
  • IBS-D treatment failure
  • Weight loss, malnutrition findings
  • Nocturnal diarrhea
  • Yellow-green oily stool

Treatment Methods

01
SeHCAT test (gold standard, retention <15% diagnostic)
02
Serum C4 (>52 ng/mL diagnostic)
03
Stool 48-hour bile acid measurement
04
Cholestyramine 4 g 1-3 times/day (first-line)
05
Colesevelam (better tolerated)
06
Colestipol
07
Low-fat diet (<40 g/day)
08
Vitamin B12, fat-soluble vitamin support
09
Loperamide for symptoms
10
Underlying disease treatment (Crohn's, etc.)

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.