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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.

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Physiology of bile acid diarrhoea

Bile acid diarrhoea (BAD) is a common but under-recognised cause of chronic functional diarrhoea, accounting for up to a third of patients who otherwise would be labelled as diarrhoea-predominant irritable bowel syndrome (IBS-D).

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Prevalence of irritable bowel syndrome–type symptoms in patients with celiac disease: a meta-analysis

Sainsbury A, Sanders D & Ford A. Clin Gastroenterol Hepatol 2013;11:359–365.

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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.

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High prevalence of idiopathic bile acid diarrhoea among patients with diarrhoea-predominant irritable bowel syndrome based on Rome III criteria

Aziz, I, Mumtaz S, Bholah H et al. Clin Gastroenterol Hepatol 2015;13:1650–1655.

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Bile acid disease: the emerging epidemic 

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

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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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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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Inflammatory bowel disease: clinical aspects and treatments

Fakhoury M et al. J Inflamm Res 2014;7:113–120.

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Diarrhoea symptoms in inflammatory bowel disease

We do not know exactly why patients with inflammatory bowel disease (IBD) have clinical symptoms. There is no correlation between endoscopic lesions and the clinical manifestations assessed by the Crohn’s disease activity index.

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Mechanism of bile acid diarrhoea
Professor Julian R.F. Walters

Professor Walters explores the classification of different causes of bile acid diarrhoea (BAD). Professor Walters describes the normal entrohepatic circulation of bile salts and what occurs when the system does not function correctly. 

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Symptoms of irritable bowel syndrome

Symptoms in this patient point towards a diagnosis of irritable bowel syndrome (IBS)IBS is characterised by the presence of recurring abdominal pain linked to changes in the pattern of bowel movements, be it constipation, diarrhoea, or both.

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Let's talk about irritable bowel syndrome (IBS)
Professor David S. Sanders 

Professor Sanders highlights that many patients presenting with irritable bowel syndrome (IBS) have underlying diseases. 

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Challenging current views on bile acid diarrhoea and malabsorption

Guidance for the use of tauroselcholic (75selenium) acid (SeHCAT) for the investigation of diarrhoea due to bile acid malabsorption (BAM)...

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Welcome to GutNEWS.org

A new web hub focussed on providing gastroenterologists with the latest information on the diagnosis, treatment and management of patients with gut related disorders.

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Enfermedad Inflamatoria Intestinal (EII) Información al paciente (Spanish)

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Síndrome de intestino irritable (SII) Información al paciente (Spanish)

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Diarrea por ácidos biliares (DAB) Información al paciente (Spanish)

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Inflammatory bowel disease (IBD) patient information sheet (English)

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Irritable bowel syndrome (IBS) patient information sheet (English)

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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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Bile acid diarrhoea (BAD) patient information sheet (English)

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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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