Bile acid diarrhea – as bad as it gets?

Abstract

Purpose of review Bile acid diarrhea (BAD) is a common but under-recognized gastrointestinal condition that manifests with increased stool frequency and urgency, and a looser stool consistency. The aim of this review is to present recent advances in the pathophysiology, mechanisms, manifestations, diagnosis, and treatment of BAD. Recent findings Patients with BAD have evidence of accelerated colonic transit, increased gut mucosal permeability, altered stool microbiome composition, and decreased quality of life. Single, random stool measurements of bile acids, alone or in combination with fasting serum 7-alpha-hydroxy-4-cholesten-3-one, have shown good sensitivity and specificity for the diagnosis of BAD. Novel therapeutic approaches include farnesoid X receptor agonists and glucagon-like peptide 1 agonists. Summary Recent research has led to a better understanding of the pathophysiology and mechanisms of BAD, which might pave the way towards more targeted treatment strategies for BAD. Newer, more affordable, and easier diagnostic methods facilitate the diagnosis of BAD.

The Gluten-Free Diet for Celiac Disease: Critical Insights to Better Understand Clinical Outcomes

“…In this context, dietary transgressions are an essential bias in interpreting the clinical course of these patients [ 12 , 16 , 138 ]. An associated pathology is the actual cause of the ongoing symptoms: microscopic colitis [ 147 , 148 , 149 , 150 ], SIBO [ 151 , 152 , 153 , 154 ], malabsorption of simple carbohydrates (e.g., lactose, fructose, or sorbitol) [ 155 , 156 , 157 ], and others such as reflux dysmotility [ 135 ], PEI [ 158 , 159 ], idiopathic bile salt malabsorption [ 160 , 161 , 162 ], Crohn’s disease, [ 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 , 171 , 172 , 173 ], and other functional digestive disorders, including irritable bowel syndrome [ 174 , 175 , 176 ]. In such patients, it is obvious that the nature of the symptoms is due to a different cause that overlaps with that of CeD itself.…”