Managing bile acid diarrhea: aspects of contention
File(s)
Published version
Author(s)
Walters, Julian RF
Sikafi, Rafid
Type
Journal Article
Abstract
Introduction
Bile acid diarrhea is a common cause of bowel symptoms and often goes unrecognized or misdiagnosed. Many aspects of management remain contentious.
Areas Covered
The primary, idiopathic condition should be suspected in people with functional diarrhea or diarrhea-predominant irritable bowel syndrome. Secondary causes include ileal resection, inflammation, and post-cholecystectomy. Diagnostic tests vary globally, being unavailable in many countries, and further refinement of testing strategy is needed. Management is usually long-term symptom control, rather than reversal of the causative factors, which are still being defined. Bile acid sequestrants remain the main drugs used. They are relatively inexpensive, and better-quality data is now available for colesevelam. However, optimal use, including timing and formulation, needs clarification. The GLP-1 receptor agonist, liraglutide, is also effective, although mechanisms of action and whether this effect is common to other class members is unclear. They are more expensive, and availability varies. FXR agonists can also be effective but require further validation. The role of dietary factors in symptom development is a major patient concern, needing more formal studies.
Expert opinion
To build on recent findings, bile acid diarrhea needs further investment into causes, diagnosis and therapy to guide present and future patient care.
Bile acid diarrhea is a common cause of bowel symptoms and often goes unrecognized or misdiagnosed. Many aspects of management remain contentious.
Areas Covered
The primary, idiopathic condition should be suspected in people with functional diarrhea or diarrhea-predominant irritable bowel syndrome. Secondary causes include ileal resection, inflammation, and post-cholecystectomy. Diagnostic tests vary globally, being unavailable in many countries, and further refinement of testing strategy is needed. Management is usually long-term symptom control, rather than reversal of the causative factors, which are still being defined. Bile acid sequestrants remain the main drugs used. They are relatively inexpensive, and better-quality data is now available for colesevelam. However, optimal use, including timing and formulation, needs clarification. The GLP-1 receptor agonist, liraglutide, is also effective, although mechanisms of action and whether this effect is common to other class members is unclear. They are more expensive, and availability varies. FXR agonists can also be effective but require further validation. The role of dietary factors in symptom development is a major patient concern, needing more formal studies.
Expert opinion
To build on recent findings, bile acid diarrhea needs further investment into causes, diagnosis and therapy to guide present and future patient care.
Date Issued
2024-09-01
Date Acceptance
2024-09-05
Citation
Expert Review of Gastroenterology and Hepatology, 2024, 18 (9), pp.521-528
ISSN
1747-4124
Publisher
Taylor and Francis Group
Start Page
521
End Page
528
Journal / Book Title
Expert Review of Gastroenterology and Hepatology
Volume
18
Issue
9
Copyright Statement
© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39264409
Subjects
bile acid malabsorption
CHOLESTYRAMINE
Chronic diarrhea
colesevelam
colestyramine
CROHNS-DISEASE
DOUBLE-BLIND
Gastroenterology & Hepatology
GLP-1 receptor agonist
GROWTH-FACTOR 19
HEALTH
ILEAL DISEASE
IRRITABLE-BOWEL-SYNDROME
Life Sciences & Biomedicine
liraglutide
MALABSORPTION
obeticholic acid
OBETICHOLIC ACID
Science & Technology
SeHCAT test
SEQUESTRANT
tropifexor
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2024-09-16