[Diagnosis and treatment of bile acid diarrhea]

This review concerns the diagnosis and therapy of bile acid diarrhea, a common type of chronic diarrhea which is considered underdiagnosed with a presumed prevalence of approximately 1%. A simple blood test, S-7-OH-cholestenone/cholesterol ratio, reflecting the bile acid synthesis rate, is a cost-effective analysis to diagnose most patients. Results above 25 nmol/mmol supports the diagnosis, while results <15 nmol/mmol are considered normal. Supplementary 75SeHCAT test may be required for results occurring in the grey zone (15-25 nmol/mmol). The latter investigation is more expensive and utilizes a radioactive isotope. Treatment for bile acid diarrhea consists of bile acid sequestrants that need to be titrated carefully in each patient to achieve lasting results. Future treatment options may include GLP-1 agonists. It is essential to spread information about the condition among general practitioners and physicians in other disciplines who will meet patients with symptoms of diarrhea.