Bile acid malabsorption: symptoms and treatment

Written by: Dr Aathavan Loganayagam
Published: | Updated: 12/02/2021
Edited by: Laura Burgess

Excess bile acids entering your colon can lead to uncontrollable diarrhoea and abdominal cramps, which are symptoms of the condition known as bile acid malabsorption (BAM). We asked one of our leading London gastroenterologists Dr Aathavan Loganayagam all about BAM, including whether it could be confused with IBS and how it is treated.



What is bile acid malabsorption (BAM)?

Bile acids or bile salts are substances that can be found in bile; which is produced by the liver and is stored in the gallbladder. Bile acids are released into the small intestine every time when we have a meal containing fats as it helps in fat digestion and absorption.

Usually, approximately 95% of these bile acids will be reabsorbed in the last portion of the small intestine (ileum) and be stored in the liver until the next time we eat a meal.

Bile acid malabsorption (BAM) or bile acid diarrhoea (BAD) is a condition whereby most bile acids are not reabsorbed in the ileum and entered the colon. The presence of an excessive amount of bile acids in the colon causes irritation to the bowels (large intestine) thereby causing symptoms such as frequent uncontrolled diarrhoea, smelly winds and crampy pains.

What are the different types of BAM?

There are three types of BAM based on their respective causes:

  • Type 1 – Bile acid malabsorption due to removal of part of the small intestine (ileum) or inflammation of the ileum (Crohn’s disease).
  • Type 2 – Primary bile acid malabsorption or no clearly defined cause.
  • Type 3 – This is due to other gastrointestinal diseases including small intestinal bacterial overgrowth, coeliac disease, chronic pancreatitis, and post-radiation.

Could it be irritable bowel syndrome (IBS) or BAM?

IBS is a condition that affects the intestine, with sufferers experiencing uncomfortable symptoms including abdominal pain, bloating, chronic diarrhoea or constipation, or both. As the symptoms of IBS are very similar to BAM (especially with diarrhoea-predominant IBS), BAM is usually misdiagnosed.

One of the well-known tests to diagnose BAM is SeHCAT (75Se-homocholic acid taurine) scan. In this scan, clients will swallow a capsule containing synthetic bile acids with small amount of ionising radiation. The bowel function is measured by how well the substance is retained or lost from the body into the faeces.

What are the treatments for BAM?

BAM can be treated by medication and a low-fat diet. Medications used to treat BAM are bile acid binders such as Cholestyramine, Colestipol, and Colesevelam. These medications work by binding with bile acids thus reducing its reaction to the colon

You can book an appointment with Dr Loganayagam via his Top Doctor’s profile here if you would like his expert medical opinion in your case.

By Dr Aathavan Loganayagam

Dr Aathavan Loganayagam trained in medicine at Guy’s, King's and St. Thomas’ medical schools. He then underwent rigorous structured specialty training in gastroenterology and general internal medicine in the well respected South London training programme.

He then spent two years during postgraduate training as a research and endoscopy fellow at Guy’s and St Thomas’ Hospitals, London. His research was in the fields of pharmacogenetics, inflammatory bowel disease and gastrointestinal malignancy. He has received awards and grants for outstanding research work, including the prestigious NHS Innovation London Award.

Dr Loganayagam has numerous publications in peer reviewed journals on all aspects of gastroenterology. He is actively involved in clinical research. He has particular local expertise in the practice of personalised medicine and the utilisation of novel therapeutic agents in the treatment of complex inflammatory bowel disease. He is currently the lead clinician for endoscopy at Queen Elizabeth Hospital, Woolwich.

Diagnostic and advanced therapeutic endoscopy remains a major part of his clinical expertise, including assessment and treatment of inflammatory bowel disease, strictures, polyps and cancers.

Dr Loganayagam is an approachable doctor who takes pride in his communication skills with patients. He is keen to ensure that patients are fully informed and involved in all aspects of their care.

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