Bile Acid Diarrhoea: Pathophysiology, Diagnosis and Management
SMALL BOWEL AND NUTRITION Frontline Gastroenterol: first published as 10.1136/flgastro-2020-101436 on 22 September 2020. Downloaded from REVIEW Bile acid diarrhoea: pathophysiology, diagnosis and management Alexia Farrugia ,1,2 Ramesh Arasaradnam 2,3 1Surgery, University Hospitals ABSTRACT Coventry and Warwickshire NHS Key points The actual incidence of bile acid diarrhoea Trust, Coventry, UK 2Divison of Biomedical Sciences, (BAD) is unknown, however, there is increasing ► Idiopathic bile acid diarrhoea (BAD) is due University of Warwick, Warwick evidence that it is misdiagnosed in up to 30% Medical School, Coventry, UK to overproduction of bile acids (rather with diarrhoea-pr edominant patients with 3Gastroenterology, University than malabsorption). Hospitals of Coventry and irritable bowel syndrome. Besides this, it may ► The negative feedback loops involved in Warwickshire NHS Trust, also occur following cholecystectomy, infectious bile acid synthesis are interrupted in BAD Coventry, UK diarrhoea and pelvic chemoradiotherapy. but there is lack of data regarding what BAD may result from either hepatic Correspondence to causes the interruption. Professor Ramesh Arasaradnam, overproduction of bile acids or their ► There is increasing evidence of an Gastroenterology, University malabsorption in the terminal ileum. It can result interplay between the gut microbiota, Hospitals of Coventry and in symptoms such as bowel frequency, urgency, farnesoid X receptor and fibroblast growth Warwickshire NHS Trust, factor 19 in BAD. Coventry CV2 2DX, UK; R. nocturnal defecation, excessive flatulence, Tests for BAD such as SeHCAT are not Arasaradnam@ warwick. ac. uk abdominal pain and incontinence of stool. ► available worldwide but alternatives Bile acid synthesis is regulated by negative Received 18 February 2020 include plasma C4 testing and possibly Revised 14 May 2020 feedback loops related to the enterohepatic faecal bile acid measurement.
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