Premium Nahrungsergänzungsmittel | artgerecht

Bile Acid Diarrhoea – Causes, Symptoms and Treatment

Bile acid diarrhoea is a chronic diarrhoeal condition caused by excess bile acids reaching the colon. It commonly occurs after small bowel surgery or in association with conditions such as Crohn's disease.

Regular tips about health Regular tips about health

Things worth knowing about "Bile Acid Diarrhoea"

Bile acid diarrhoea is a chronic diarrhoeal condition caused by excess bile acids reaching the colon. It commonly occurs after small bowel surgery or in association with conditions such as Crohn's disease.

What is Bile Acid Diarrhoea?

Bile acid diarrhoea (also known as bile acid malabsorption or bile salt diarrhoea) is a form of chronic diarrhoea that occurs when excess bile acids pass into the large intestine (colon). Under normal circumstances, bile acids are reabsorbed in the final section of the small intestine (terminal ileum) and recycled by the body. When this process is disrupted, the excess bile acids irritate the lining of the colon and stimulate fluid secretion, resulting in watery diarrhoea.

Causes

Bile acid diarrhoea can be triggered by a variety of medical conditions and surgical procedures:

Surgical resection of the terminal ileum: for example in Crohn's disease or colorectal cancer, removing the segment responsible for bile acid reabsorption
Crohn's disease: a chronic inflammatory bowel disease that can affect the ileum and impair its function
Cholecystectomy: removal of the gallbladder, after which bile acids flow continuously into the intestine rather than being stored
Idiopathic bile acid malabsorption: occurring without an identifiable underlying cause, often overlapping with irritable bowel syndrome (IBS)
Pelvic radiotherapy, which can damage the ileum
Coeliac disease or other conditions causing damage to the small intestinal mucosa

Symptoms

Typical symptoms of bile acid diarrhoea include:

Watery, often yellow-coloured diarrhoea
Sudden and urgent need to defecate
Abdominal cramps and bloating
Frequent bowel movements, including at night
In severe cases: weight loss and nutritional deficiencies

Diagnosis

Several methods can be used to diagnose bile acid diarrhoea:

SeHCAT test (selenium-75 homocholic acid taurine test): a nuclear medicine scan in which a radiolabelled bile acid is swallowed and its retention is measured over seven days. Low retention values indicate bile acid malabsorption.
Serum C4 levels (7-alpha-hydroxy-4-cholesten-3-one): elevated levels indicate increased bile acid synthesis and suggest malabsorption.
Stool bile acid measurement
Exclusion of other causes through colonoscopy and laboratory tests

Treatment

Treatment depends on the underlying cause and the severity of symptoms:

Medication

Bile acid sequestrants (anion exchange resins): First-line treatments include cholestyramine, colesevelam, and colestipol. These medications bind excess bile acids in the intestine, preventing them from irritating the bowel lining.
Budesonide: A locally acting corticosteroid that may be used in cases where microscopic colitis is a concurrent diagnosis.

Dietary Adjustments

A low-fat diet may help, as dietary fat stimulates bile acid production
Smaller, more frequent meals are often better tolerated
Adequate fluid intake to compensate for fluid losses

Treatment of the Underlying Condition

In cases related to Crohn's disease or other underlying conditions, treating the root cause is an essential part of management. Close collaboration with a gastroenterologist is recommended.

References

Walters, J. R. F. (2014): Bile acid diarrhoea and FGF19: new views on diagnosis, pathogenesis and therapy. Nature Reviews Gastroenterology and Hepatology, 11(7), 426-434.
Wedlake, L. et al. (2009): Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Alimentary Pharmacology and Therapeutics, 30(7), 707-717.
National Institute for Health and Care Excellence (NICE): Bile acid malabsorption -- diagnosis and management. NICE guideline evidence review (2023).

Building Blocks for a Healthy Life

As an integrated manufacturer, we develop & produce evidence-based, patented, and non-patented formulations. We work exclusively with plant and natural extracts according to the strictest purity & quality standards.
The combination of science & modern technology with the laws of nature creates solutions consistently tailored to humans – for the highest good: health.