Crohn's Disease Forum » General IBD Discussion » Bile Acid Malabsorption

05-21-2011, 08:09 AM   #1
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Bile Acid Malabsorption

Recently had a meeting with my doctor at the outpatients clinic. He seems pretty certain that I have 'Bile Acid Malabsorption', which is fairly common after surgery with Crohn's Patients. I've been prescribed this drink, which he says tastes like "wallpaper paste", which I need to take four times a day to calm the diarrhoea.

Anyone else have this?

"Patients with bile acid malabsorption typically present with chronic, watery diarrhea. Bile acids recirculate between the liver and small intestine in the enterohepatic circulation. They are reabsorbed in the distal small intestine, and normally only a small fraction of the bile acid pool is lost to the colon during each cycle. In patients with bile acid malabsorption, a larger amount of bile acids is spilled into the colon, where the acids stimulate electrolyte and water secretion, which results in loose to watery stools. The common causes of bile acid malabsorption are ileal resection and diseases of the terminal ileum (Crohn’s disease and radiation enteritis), which result in a loss of bile acid transporters and, consequently, diminished reabsorption. Bile acid malabsorption also has been documented in a small group of patients with chronic, watery diarrhea who have no demonstrable ileal disease (idiopathic bile acid malabsorption). The amount of bile acid loss to the colon determines the clinical presentation. Patients with mild to moderate bile acid malabsorption present with watery diarrhea and generally respond very well to treatment (with abolishment of diarrhea) with bile acid binders such as cholestyramine. Patients with more severe bile acid malabsorption have both diarrhea and steatorrhea. Treatment with cholestyramine is of no benefit in this group of patients and may, in fact, worsen steatorrhea. These patients are best treated with a low-fat diet supplemented with medium-chain triglycerides. "
05-21-2011, 03:05 PM   #2
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My daughter has this. I don't know that I agree with this statement...

Patients with more severe bile acid malabsorption have both diarrhea and steatorrhea. Treatment with cholestyramine is of no benefit in this group of patients and may, in fact, worsen steatorrhea.
I would have considered Sarah to be in the more severe group and cholestyramine (Questran Lite) worked very well in her case. The only problem was, she found it so unpalatable that she refused to continue taking it. She was 14 at the time so that may have had something to do with her non compliance. When the GI asked her about how she was going with it and she said she wasn't taking it he wasn't surprised.

She has tried Imodium, Lomotil and commercially produced brands of psyllium husks (Metamucil etc) but found these all caused pain and cramping.

She ended up planning her eating around her day which, while it worked, wasn't really a satisfactory outcome. Over time she found natural psyillium husks worked very well and she has also now moved to a vegan diet and this has also had a marked effect on the amount of times she uses her bowels a day. She doesn't always use the psyllium if she is home for the day but when she does she goes once a day. It is one of those things that is trial and error and she has it down to a fine art but it can be a fine line between it not working and bunging yourself up when starting!

If you search cholestyramine or Questran you will find a number of threads about it and I think someone has recently posted about how they have managed to find a way to make it palatable, something to do with ?apple juice.

Good luck!
Dusty. xxx
Mum of 2 kids with Crohn's.
07-19-2012, 03:37 AM   #3
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Hi there, I was recently diagnosed with Bile Acid Malabsorption after almost 30 years of multiple issues. I was first suspected of having Crohn's when I was still in high school, but never any conclusive results from the on again, off again symptoms. But about 6 months ago, the symptoms became so severe that I could barely work and spent my days either in the bathroom, or in bed from exhaustion. I had kind of suspected I wasn't getting any kind of nutrtients in my system because everything was just going right through and I lost about 20 lbs in 6 weeks. And I was getting so dehydrated. My GP ran a few tests and had me try Welchol for 2 weeks, which did help, but the symptoms came back even worse when I tried to stop taking it. The powder form was disgusting. I took mine with grape juice and it seemed to go down a lot easier. My GP switched me to the tablets and then sent me to see the GI. Also during this time, my blood pressure had gone from a pretty normal reading of around 120/80, to an average of 165/90 within just a few months. And on the day of my GI appt, it was at 180! The GI ordered a bunch of tests and a colonoscopy and endoscopy. The bloodwork showed I have no vitamin D3. He told me to take 5000 iu per day. The capsules didn't seem to phase anything. One of my friends stakes the sublignual vitamin B12 liquid, so I started looking for the vitamin D3 in a liquid form and was lucky enough to find some drops at the grocery store. I had read that it is easier for the liquid to be absorbed since the stomache doesn't have to try to break down and digest the outer capsules first. The liquid really does seem to make a difference and I started feeling more energy within just a couple of weeks. But I actually take more like 7000iu per day on average and feel like anything less doesn't really help. The GI suspected maybe eschemic colitis, Celiac or once again, Crohn's. He did find a hiatal hernia during the endoscopy, but otherwise everything else, including the colonoscopy looked normal on the surface. The biopsy came back showing irritation and inflamation, but he said not the kind of damage that they would see in Crohn's. And the rest of the tests ruled out Celiac and colits. The SeHCat test is not available in the US. So he basically deduced that I have Bile Acid Malabsorption because I have improvement with the Welchol. I am a little sceptical, just because I have had so many other medical issues and never any actual diagnosis for any of them. Just a lot of guesses. So I am just going with that for now. I have not really been able to find very much information about it at all, other than it hasn't even been studied that much until recently, like within the last 20 years. I guess this is why there aren't that many people out there with this diagnosis since a lot of doctors have never even heard of it. Well, the vitamin D3 drops have really helped a lot, and my bp has even started coming back down again already. Now it is more of an average in the 150s/90. But I am still struggling with the best way and time to take the Welchol. I have tried it at various times of day and so far haven't found one that really works well. There are some side effects such as some really bad cramping and pain, and a lot of gas. And it hasn't completely eliminated the D, but it is way better than before. So I am greatful for that. At least most days I am able to work a full day again. But most days I still feel around 50%-80%. Sometimes I wish I could just lay down and go back to bed until the pain goes away. I have tried to see which foods cause issues and which ones don't. Can't really seem to figure that out yet. There doesn't really seem to be any kind of pattern yet. One thing that I have noticed is that I absolutely have to drink a ton of water now. All the time. If I go too long without drinking anything, my mouth feels so dry like sawdust and I start to feel the effects of the dehydration. The other thing I have noticed is that if I am able to eat small snacks pretty much continuously, like crackers or pretzels or something, that does seem to help. But who can be constantly eating all day long? It can be very difficult. But if my stomache gets too empty, then the feeling of starvation comes on very quickly and my tummy growls very loudly, and by then it's too late. My bowels get totally messed up again and it takes a day or two for them to start to feel a little better. Just in time for it to start the cycle all over again. Ugh. I have been looking around for anyone that has been through this for any kind of advice of what I can try that might help as far as timing the meds, possible foods to avoid, foods that might help, etc. Dusty, you say your daughter has it down to an art. I am jealous and hope to achieve that one day. Any suggestions you could give me would be great. I did see a few of your posts that she takes the natural psyllium husks. I'm not sure I would be ready to switch to that just yet since it's only been about 4 months with the Welchol. But at some point, if this is as good as it can get, then I will be willing to try anything. Thank you.
07-19-2012, 04:59 AM   #4
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Hey Pebbles,

Whoa, you have certainly been the wringer over the years......I surely hope you find some relief ASAP!

Aside from the scopes have you had any other testing done for IBD?
Scoping leaves almost all the small bowel uncharted, has imaging of any kind been done?

Have you had blood tests for inflammatory markers (CRP & ESR)?

Along with Vit D did they test the levels of B12, Folate and Iron Stores?

Here is an excellent thread about Vit D...

and another about B12 in the wiki...

Do you keep a diary of your symptoms?
If not have a look at the suggestions we have in the wiki...

...I know you aren't new to chronic issues but I always found that living with something day in and day out made me forget the little things simply because they became the new norm.

As to Sarah...she is now 6 years in remission (following surgery) and is on a raw vegan diet. I have specifically said she is in remission because I don't know that diet she follows would be very suitable for someone with inflammation. She no longer uses psyllium and has normal bowel movements. I personally believe it is a result of her diet and likely some natural take up by the bowel over time.

My son had surgery in April of last year and he also uses psyllium. His diarrhoea was never as severe as Sarah's as his resection was far more conservative, it has however had the same effect of allowing him get out and live his life. I didn't pursue any other path with him.

Sorry for all the questions!

Dusty. xxx
07-25-2012, 10:31 PM   #5
Join Date: Jul 2012
Location: Brampton, Ontario
I suffer with bile acid malabsorption. Only started after resection and removal of gall bladder. Diahrea 20 times a day pure liquid. Lost about 25 lbs. GI prescribed Colestid. Although I have to take 16 a day, works way better than cholestrymine and it's been a LIFESAVER! Highly recommend ColEstid.
09-24-2013, 06:15 AM   #6
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I've just been diagnosed with this - leading my gastro who had otherwise dismissed me as IBS to run closer tests on my ileum - YAY!
09-26-2013, 09:02 PM   #7
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From what I am reading the portal vein recirculates bile acid to the liver. Is there a way to know if that vein is working like it should be or not pre and post surgery?
02-01-2017, 05:48 PM   #8
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Has anyone had bile malabsorption after a resection and then a year later taken them selves of colectagel and been back to normal?

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