This can cause chronic, waterydiarrhea.
Bile acid is a component ofbile, which is a yellow-green fluid that aids in digestion.
BAD is also known as bile acid malabsorption (BAM).
Verywell / Nusha Ashjaee
Malabsorption is an inability of the body to properly absorb certain substances.
Some research suggests BAD may not always be due to malabsorption, though.
Some researchers feel anyone with chronic diarrhea of unknown cause should be evaluated for BAD.
This article will discuss bile acid diarrhea, its symptoms, and its causes.
It will also discuss diagnosis and treatment of the condition.
Symptoms of Bile Acid Diarrhea
The primary symptom of BAD is chronic bouts of diarrhea.
Chronic diarrhea is defined as having three or more loose bowel movements a day for at least four weeks.
Causes of Bile Acid Diarrhea
Bile acids are produced by your liver and stored in yourgallbladder.
When you eat foods containing fat, these acids are released into thesmall intestine.
There, they break down fats so your body can absorb them.
In people with BAD, large amounts of bile acid get flushed into the large intestine.
This causes an increase in fluid in the intestine.
The movement of fluid through the intestines speeds up and the result is watery stools.
Researchers once thought BAD was a problem with malabsorption.
SeHCAT is a mildly radioactive synthetic bile acid that shows up on a full-body scan.
Patients undergoing this test receive one scan a few hours after taking the SeHCAT.
A second scan is performed a week later.
The test looks at how well the small intestine retains bile acids.
If the retention rate is lower than 15%, it indicates BAM.
Some healthcare providers use a trial of a medication to treat BAD.
If the medication improves symptoms, BAD is diagnosed.
Elevated levels of 7C4 can indicate BAM or BAD.
IBS-D or Functional Diarrhea
Researchers believe many people with IBS-D or functional diarrhea actually have BAD.
Studies suggest BAD may be behind approximately one-third to one-half of cases of IBS-D or chronic diarrhea.
Bile acid sequestrants are FDA-approved to treat high blood cholesterol.
They are prescribed off-label to treat BAM.
These medications bind to bile acids and reduce their effects on the large intestine.
This class of drugs includes:
These medications are usually effective in treating the symptoms of BAD.
Unfortunately, they are not well-tolerated by many patients.
Side effects can include constipation and other digestive symptoms.
Because of this, patients may choose to discontinue treatment, especially if they have not received a diagnosis.
Drugs in this class may affect the absorption of other medications.
For that reason, you should take them four to six hours before or after any other medications.
Is There a Natural Remedy for Bile Acid Diarrhea?
However, treatment with medication is the most effective way to manage bile acid diarrhea.
Summary
Bile acid diarrhea is a condition that causes chronic diarrhea.
It is due to excess bile acid in the large intestine.
In the United States, healthcare professionals rely on stool tests and medication trials to diagnose the condition.
BAM can be treated with medication.
If you have been diagnosed with IBS-D or have undiagnosed chronic diarrhea, talk to your healthcare provider.
You may want to find out if this underdiagnosed condition is at the root of your symptoms.
Farrugia A, Arasaradnam R.Bile acid diarrhoea: pathophysiology, diagnosis and management.Frontline Gastroenterol.
2021;12:500-507. doi:10.1136/flgastro-2020-101436
Vijayvargiya P, Camilleri M.Current practice in the diagnosis of bile acid diarrhea.Gastroenterol.
2019;156(5):1233-1238. doi:10.1053/j.gastro.2018.11.069
Memorial Sloan Kettering Cancer Center.Diarrhea.
Stanford Medicine.Chronic diarrhea symptoms.
2020;11(5):358-363. doi:10.1136/flgastro-2019-101301
Ahmed M.Functional, diagnostic and therapeutic aspects of bile.CEG.
2022; 15:105-120. doi:10.2147/ceg.s360563
Labcorp.7AlphaC4 (7 alpha-hydroxy-4-cholesten-3-one).
Camilleri M.Bile acid diarrhea: prevalence, pathogenesis, and therapy.Gut Liver.
2012;36(10):32-44.
