Bile acid disease: the emerging epidemic 

Oduyebo I & Camilleri M. Curr Opin Gastroenterol 2017;33:189–195.

Short summary

Type 2 (primary) bile acid diarrhoea (BAD) is associated with increased bile acid production and occurs in nearly 30% of patients with diarrhoea-predominant irritable bowel syndrome (IBS-D). Primary BAD is associated with disorders of serum fibroblast growth factor 19 (FGF-19) which results in excess bile acid synthesis by hepatocytes. This leads to higher concentrations of bile acids in the colon and increased faecal bile acid loss.

The tauroselcholic (75selenium) acid (SeHCAT) test is the most commonly used test for the diagnosis of BAD. A retention of SeHCAT of less than 10% is indicative of moderate BAD; less than 5% retention suggests severe BAD. Measurement of fasting levels of FGF-19 may have diagnostic value; levels are lower in patients with BAD compared with diarrhoea controls.

Bile acid sequestrants provide symptom relief and are the treatment of choice for BAD. Patients will likely require long term therapy; tolerability is the main reason for discontinuation. A low-fat diet improves gastrointestinal symptoms when used alone in patients with mild BAD or in combination with bile acid sequestrants in patients with severe BAD. 

Job number: JB01815UK. Date of Preparation: May 2022

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How common is bile acid diarrhoea (BAD)?
Professor David S. Sanders 

How common is bile acid diarrhoea (BAD)?
Professor David S. Sanders 

Professor Sanders argues that many patients presenting with irritable bowel syndrome (IBS) have underlying diseases. He explores a series of studies that suggest approximately 25% of patients presenting with IBS symptoms have BAD as the underlying cause. 

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