Prevalence and clinical features of bile acid diarrhea in patients with chronic diarrhea

Abstract

ObjectiveBile acid diarrhea is a form of chronic diarrhea caused by excessive bile reaching the colon. Conditions involving the terminal ileum and cholecystectomy are predisposing factors but an idiopathic form of bile acid diarrhea has also been described. In this study we aimed to evaluate the prevalence of bile acid diarrhea in patients consecutively evaluated for chronic diarrhea in an Outpatient Gastroenterology Clinic.MethodsMedical records of all patients admitted for chronic diarrhea (>4 weeks) between June 2018 and April 2019 were retrospectively reviewed. Bile acid diarrhea was suspected in patients with ileal disease, cholecystectomy or post‐prandial diarrhea. Patients’ age at diagnosis, sex, presenting symptoms, results of main test and examinations, final diagnoses and date of last follow‐up visit were also collected. Exclusion of chronic diarrhea of other causes and a 6‐month clinical improvement with cholestyramine treatment confirmed the diagnosis of bile acid diarrhea.ResultsIn total, 139 patients aged 46 ± 20 years (76 women and 63 men) were included. Diarrhea due to an organic cause was diagnosed in 16 patients. A clinical response to cholestyramine persisting for more than 6 months led to a diagnosis of bile acid diarrhea in 39 (aged 52 ± 19 years) out of the remaining 123 patients with functional forms of diarrhea. Therefore, the prevalence of bile acid diarrhea was 28.1% (95% confidence interval 19.9%‐38.4%) in patients with chronic diarrhea.ConclusionsBile acid diarrhea is a very common, yet under‐recognized cause of chronic functional diarrhea. A therapeutic trial of cholestyramine is a valid diagnostic strategy.

Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility

“…99 A trial of therapy with colestyramine was suggestive for bile acid diarrhoea in 28% of patients with chronic diarrhoea. 100 We concur with consensus guidelines developed independently, which recommend testing to exclude bile acid diarrhoea, with SeH-CAT or other biomarkers, as available, in all patients with unexplained chronic diarrhoea. Summary of evidence: SIBO is defined by excessive and/or an abnormal type of bacteria in the small bowel.…”

“…In patients with Rome IV criteria for IBS‐D, bile acid diarrhoea was the most common organic disease diagnosed 99 . A trial of therapy with colestyramine was suggestive for bile acid diarrhoea in 28% of patients with chronic diarrhoea 100 …”

Variation in the length of terminal ileum specimen in right hemicolectomy: a descriptive study

“…[11][12][13][14][15][16] Bile acid malabsorption is well described in the literature regarding resection of terminal ileum. Alterations in bile acid absorption may be associated with both functional and organic types of chronic diarrhoea, [17][18][19] and the variation we found in the length of terminal ileum specimens could theoretically give various clinical types of chronic diarrhoea due to alterations in bile acid absorption. 18 A study found that the severity of diarrhoea, expressed as faecal weight, corresponded to the length of removed ileum and colon, 20 and this emphasizes the importance of the length of the specimens.…”

“…Alterations in bile acid absorption may be associated with both functional and organic types of chronic diarrhoea, [17][18][19] and the variation we found in the length of terminal ileum specimens could theoretically give various clinical types of chronic diarrhoea due to alterations in bile acid absorption. 18 A study found that the severity of diarrhoea, expressed as faecal weight, corresponded to the length of removed ileum and colon, 20 and this emphasizes the importance of the length of the specimens. Another study found no correlation between B12 malabsorption and < 20 cm of resected terminal ileum, 21 and with an upper limit of terminal ileum specimen length of 17 cm in this study, we do not know if it is of relevance in the general population of patients after standard right hemicolectomy.…”

Bile Acid Sequestrants for Hypercholesterolemia Treatment Using Sustainable Biopolymers: Recent Advances and Future Perspectives

“…The BASs are also proven to be efficacious in the treatment of chronic diarrhea due to the malabsorption of BAs/BSs, often termed as bile acid diarrhea (BAD). − Studies had shown that patients with post-ileocecal resection experience a reduction in stool frequency and had an improvement in consistency of stool on a specific dose of cholestyramine per day; additionally, the urgency of defecation, perianal soreness, and flatus were also decreased in most cases. In patients with mild diarrhea, bile acid sequestrants provide symptomatic relief by lowering the concentration of free bile acids in the colon. ,− Figure represents the list of off label use of BASs reported in various literature and research guidelines.…”