Bile acid malabsorption: mechanisms and treatment

Bile acid malabsorption is often due to a disease or partial resection of the terminal ileum and more rarely a genetic defect in the distal ileum. It is often associated with diarrhoea with or without steatorrhoea, and it may be complicated by gallstone disease and hyperoxaluria. Bile acid malabsorption is rather easily diagnosed using the selenohomocholic acid taurine test. Patients with bile acid induced diarrhoea should be recommended a low-fat diet. Cholestyramine may be recommended in moderate bile acid diarrhoea. In patients with more severe bile acid malabsorption, cholylsarcosine may be used as a replacement therapy.