BILE ACID MALABSORPTION

What is Bile Acid Malabsorption (BAM)?

Bile acids are a central component for proper digestion. They are made in the liver and released through the bile duct into the gallbladder, where they are stored. When you eat, the gallbladder releases bile acids into the stomach; from there they move to the small intestine to help break down foods and help your body absorb nutrients.

Bile acid malabsorption is when excess bile acids are not properly absorbed by the intestines and accumulate there, resulting in watery diarrhea, often called bile acid diarrhea. In short, rather than be reabsorbed by the colon into the body (to be used again in the digestive cycle), people with BAM have too much bile acid in their distal small intestine. 

What Causes BAM?

In healthy people whose digestive system is functioning properly, only a tiny amount of bile acid stays in the colon and doesn’t go back through what’s called the enterohepatic cycle (between the liver and small intestine). In BAM cases, the bile acids do not properly recirculate, and patients have a larger amount of bile acids leaking into the colon. These acids trigger secretion of electrolytes and water, resulting in watery stools (diarrhea).

Common causes of bile acid malabsorption are:

●       Ileal resection – this is the surgical removal of the cecum and the terminal ileum, where the small bowel intersects with the large intestine. Ileal resection is commonly performed to treat Crohn disease.

●       Ileal diseases (diseases of the terminal ileum), including Crohn disease and radiation enteritis (inflammation of the intestines that occurs after radiation therapy).

These conditions lead to a loss of bile acid transporters, which then reduces acid reabsorption and leads to chronic diarrhea—and disrupts life for people suffering with the symptoms of this condition

What are the Symptoms of BAM?

Patients come to Dr. Habba complaining of a variety of abdominal symptoms such as watery stool, chronic diarrhea, urgency and fecal incontinence, flatulence (gas), bloating, nausea, and stomach cramps. These symptoms often lead to weight gain or loss, a lack of energy, or trouble concentrating due to abdominal distress. These symptoms are similar to those of Habba syndrome, celiac disease, Crohn disease, and other autoimmune disorders of the intestinal tract.

If Dr. Habba suspects BAM, he uses one of two tests available in the U.S. to evaluate BAM--

the serum 7αC4 test or the fecal bile acid test. 

Testing for BAM

With the fecal bile acid test, stool samples are collected for 48 hours and are examined for signs of bile acid in the lab; patients with chronic functional diarrhea have increased total fecal bile acids Patients take a stool collection kit home and must follow a special diet for two days prior to and during the 48-hour collection period.

The serum 7αC4 test is a screening test that measures fasting serum levels of a specific marker called 7α-hydroxy-4-cholesten-3-one (or 7αC4 or C4for short). It is done once during a morning fast; Dr. Habba looks for elevated levels of this serum—an indicator of BAM. 

How to Treat BAM

Medication and dietary changes—and often a combination of both—are effective treatments for BAM.

Patients with mild to moderate bile acid malabsorption generally respond very well to a class of medications called bile acid binders. These drugs bind with the acid in your digestive tract to reduce impact on the colon.

A low-fat diet is best for patients with BAM, which reduces the amount of bile acid your body produces, which in turn reduces incidence of diarrhea. While it is recommended that patients curtail intake of high-fat foods, some healthier options are avocados, fatty fish, and nuts, consumed in moderation.

Contact an experienced gastroenterologist today!

Contact Dr. Habba in Summit, NJ, for a consultation about possible bile acid malabsorption or other gastrointestinal disorders, such as Habba Syndrome or IBS.