Chronic Diarrhea? -Think Bile Malabsorption(BAM)

“The estimated prevalence of BAM is >90% in patients with resected Crohn disease (CD) and 11% to 52% of unresected CD patients (type 1); 33% in diarrhea-predominant irritable bowel syndrome (type 2); and is a frequent finding postcholecystectomy or postvagotomy (type 3).” Worth thinking about.

Can J Gastroenterol. 2013 Nov;27(11):653-9.
Bile acid malabsorption in chronic diarrhea: Pathophysiology and treatment.
Barkun AN, Love J, Gould M, Pluta H, Steinhart H.
http://www.ncbi.nlm.nih.gov/pubmed/24199211

  • article failed to load in computer
  • “Investigations include BAM fecal bile acid assay, 23-seleno-25-homo-tauro-cholic acid (SeHCAT) testing and high-performance liquid chromatography of serum 7-α-OH-4-cholesten-3-one (C4), to determine the level of bile acid synthesis.”
  • doubt if either readily available but do say:
     “An estimated 70% to 96% of chronic diarrhea patients with BAM respond to short-course cholestyramine.”

Comment – I have tried short courses of cholestyramine and will have to consider it more often… ggdb ggdb

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