Bile acid malabsorption in patients with chronic diarrhoea

The presence of bile acid malabsorption was studied in 24 patients with chronic diarrhoea without established cause despite extensive investigations. Bile acid absorption was evaluated with the 75Se-homocholic acid taurine (SeHCAT) test. A therapeutic trial of cholestyramine was performed in 11 patients. Fourteen of the patients (58%) showed evidence of bile acid malabsorption. Of the 11 patients who were treated with cholestyramine, 3 had no improvement of their diarrhoea and also had a normal SeHCAT test result. Of the other eight patients, who also had pathologic SeHCAT test result, five improved on treatment, whereas three had no change of their diarrhoea. Seven of the 24 patients had a previous history of cholecystectomy. Four of them showed bile acid malabsorption; three of these were treated with cholestyramine and responded favourably. The results suggest that bile acid malabsorption may be common in chronic diarrhoea patients but may not always be the primary cause of diarrhoea.