Bile salt malabsorption

A condition where the intestines cannot properly absorb bile acids

Bile salt malabsorption
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Synonyms	Bile acid malabsorption
Pronounce	N/A
Specialty	N/A
Symptoms	Chronic diarrhea, abdominal pain, bloating
Complications	Malnutrition, vitamin deficiencies
Onset
Duration
Types	N/A
Causes	Ileal resection, Crohn's disease, Irritable bowel syndrome
Risks
Diagnosis	SeHCAT test, fecal bile acid test
Differential diagnosis	N/A
Prevention	N/A
Treatment	Bile acid sequestrants, dietary changes
Medication	N/A
Prognosis
Frequency
Deaths	N/A

Bile salt malabsorption (BSM), also known as bile acid malabsorption, is a condition in which the intestines are unable to properly absorb bile acids. This can lead to chronic diarrhea and other gastrointestinal symptoms. Bile acids are crucial for the digestion and absorption of fats and fat-soluble vitamins in the small intestine.

Pathophysiology

Bile acids are synthesized in the liver from cholesterol and are secreted into the small intestine to aid in the digestion of dietary fats. Normally, about 95% of bile acids are reabsorbed in the ileum, the last part of the small intestine, and returned to the liver in a process known as enterohepatic circulation. In bile salt malabsorption, this reabsorption process is disrupted, leading to an excess of bile acids entering the colon, where they can cause diarrhea and other symptoms.

Causes

Bile salt malabsorption can be caused by several conditions, including:

• Ileal resection: Surgical removal of the ileum can reduce the surface area available for bile acid reabsorption.
• Crohn's disease: Inflammation of the ileum can impair bile acid absorption.
• Irritable bowel syndrome (IBS): Some patients with IBS may have bile acid malabsorption as a contributing factor to their symptoms.
• Radiation enteritis: Damage to the intestines from radiation therapy can affect bile acid absorption.

Symptoms

The primary symptom of bile salt malabsorption is chronic diarrhea, which is often watery and may be accompanied by:

• Abdominal pain
• Bloating
• Urgency to defecate
• Fatigue due to malnutrition

Diagnosis

Diagnosis of bile salt malabsorption can be challenging. Common diagnostic tests include:

• The SeHCAT test: A nuclear medicine test that measures the retention of a radiolabeled synthetic bile acid analogue.
• Fecal bile acid test: Measures the amount of bile acids in the stool.

Treatment

Treatment for bile salt malabsorption often involves:

• Bile acid sequestrants: Medications such as cholestyramine, colestipol, or colesevelam that bind bile acids in the intestine and prevent them from causing diarrhea.
• Dietary changes: Reducing fat intake can help manage symptoms.
• Addressing underlying conditions: Treating conditions like Crohn's disease can improve bile acid absorption.

Prognosis

With appropriate treatment, many patients with bile salt malabsorption can manage their symptoms effectively. However, untreated BSM can lead to complications such as malnutrition and vitamin deficiencies.

Also see

• Cholestasis
• Malabsorption
• Diarrhea
• Enterohepatic circulation