A source for healthcare professionals to access the latest data and information on the diagnosis, treatment and management of patients with gut related disorders

Experts' Opinion

Respected experts from across Europe offer their opinion on a number of issues and topics.

Are the current treatments for bile acid diarrhoea effective (BAD), and is it likely that in the future there will be better treatments for BAD?

Current therapies, such as colestyramine and colesevelam, bind and eliminate bile acids from the colon. These drugs prevent the excess bile acids causing watery faeces. 

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Is bile acid diarrhoea underdiagnosed in patients with Crohn’s disease?

Definitely, yes. Unfortunately for patients with Crohn’s disease, there is a poor relationship between their symptoms and intestinal inflammation, and a considerable proportion of patients’ present symptoms that are not due to the inflammation but rather to bile acid diarrhoea.

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What is the role of bile acid malabsorption in diarrhoea-predominant irritable bowel syndrome?

In diarrhoea-predominant irritable bowel syndrome, it has been shown that up to 40% of patients are affected by some type of bile acid metabolism disorder, either as malabsorption or with increased bile acid synthesis.

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It has been reported that at least 1 in every 20 individuals in the UK experiences irritable bowel syndrome-type symptoms or chronic diarrhoea.

Of these, how many are suspected to have bile acid diarrhoea?

In my opinion, 1% of the general population has bile acid diarrhoea (BAD) also known as bile acid malabsorption (BAM).

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What, in your opinion, are the primary or underlying mechanisms of bile acid diarrhoea?

Bile acid diarrhoea (BAD) can be caused by any problem that increases bile acids in the colon. This can be due to malabsorption when the ileus does not function correctly, such as in Crohn’s disease.

Another way that BAD can be caused is by an overproduction of bile acids. 

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What is the overall benefit for clinicians of an early diagnosis of bile acid diarrhoea?

The benefit is quite significant, both for the physician and for the patient. For physicians, it provides the possibility to avoid numerous diagnostic tests.

For example, when investigating patients with unselected irritable bowel syndrome-type symptoms the chances of successfully diagnosing a disease through colonoscopy are very low..

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What is the impact of an early diagnosis of bile acid diarrhoea for the patient, physician and healthcare system?

An early diagnosis of bile acid diarrhoea is very important for increasing patient comfort by providing an early resolution of their symptoms.

For the healthcare system, this would obviously mean fewer consultations, better and more appropriate treatments..

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