Management of bile acid malabsorption using low-fat dietary interventions: a useful strategy applicable to some patients with diarrhoea-predominant irritable bowel syndrome?

Watson L et al. Clin Med (Lond) 2015;15:536–540.

Short summary

Simple low–fat dietary interventions can result in clinically important improvements in gastrointestinal (GI) symptoms due to bile acid malabsorption (BAM) according to the results of this UK study.

Forty patients (20 male and 20 female) with a mean age of 61 years were recruited to the study. These patients had a 7-day tauroselcholic (75selenium) acid (SeHCAT) scan result of <20%. Bile acid sequestrant was administered and optimised in 25 of these patients prior to any dietary changes.

Patients completed a 7-day dietary diary before consultation with a dietitian and rated their GI symptoms using a 10-point numerical scale (NRS-10). Patients then followed a tailored, low-fat diet, which aimed to provide 20% of total energy from fat for 6–8 weeks following which their GI symptoms were reassessed.

There was a significant reduction in urgency, bloating, lack of control and bowel frequency (p≤0.01). The median symptom rating for flatulence, abdominal pain, greasy/pale stool and abdominal gurgling was also reduced (p≤0.05). Mean dietary fat intake reduced from 62.3 g to 42.2 g after intervention (p≤0.01). Mean dietary fibre intake was similar before and after intervention (14.8 g vs 14.4 g, p=not significant).

Since BAM is the cause of the GI symptoms in around half a million patients treated for diarrhoea-predominant IBS (IBS-D) by the NHS, simple dietary intervention to lower fat intake has the potential to have a widely beneficial effect.

Job number: JB01821UK Date of Preparation: May 2022

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management bile acid malabsorption low-fat diet diarrhoea irritable bowel syndrome ibs bad bam

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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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