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Bile acid malabsorption

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604:. When SeHCAT testing is performed, the diagnosis of primary bile acid diarrhea is commonly made. In a review of 18 studies of the use of SeHCAT testing in diarrhea-predominant irritable bowel syndrome patients, 32% of 1223 people had a SeHCAT 7-day retention of less than 10%, and 80% of these reported a response to cholestyramine, a bile acid sequestrant. 1967:
Camilleri M, Nord SL, Burton D, Oduyebo I, Zhang Y, Chen J, Im K, Bhad P, Badman MK, Sanders DS, Walters JR (September 2020). "Randomised clinical trial: significant biochemical and colonic transit effects of the farnesoid X receptor agonist tropifexor in patients with primary bile acid diarrhoea".
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A study from 2023 investigating the epidemiology of bile acid diarrhea in Denmark, found that people suffering from bile acid diarrhea seemed to have more co-morbidities, lower levels of income and education and more health care contacts compared with matches not suffering from bile acid diarrhea.
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had unexpected effects in clinical cases with co-existing bile acid diarrhoea which led to a randomised, double-blind, active-comparator, non-inferiority clinical trial. This trial demonstrated superiority in favour of liraglutide compared with colesevelam in reducing stool frequency and improved
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Primary bile acid diarrhea (Type 2 bile acid "malabsorption") may be caused by an overproduction of bile acids. Several groups of workers have failed to show any defect in ileal bile acid absorption in these patients, and they have an enlarged bile acid pool, rather than the reduced pool expected
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test involves two scans a week apart and so measures multiple cycles of bile acid excretion and reabsorption. There is limited radiation exposure (0.3 mSv). Retention of SeHCAT at 7 days is normally above 15%; values less than 15%, 10% and 5% predict respectively mild, moderate and severe
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A study found that patients suffering from bile acid diarrhea are characterized by a dysmetabolic and prediabetic-like profile, with higher postprandial concentrations of glucose, insulin and glucagon, compared with matched healthy controls. The underlying mechanisms are not fully understood.
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Kårhus ML, Brønden A, Forman JL, Haaber A, Knudsen E, Langholz E, Dragsted LO, Hansen SH, Krakauer M, Vilsbøll T, Sonne DP, Knop FK (October 2022). "Safety and efficacy of liraglutide versus colesevelam for the treatment of bile acid diarrhoea: a randomised, double-blind, active-comparator,
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Borup C, Vinter-Jensen L, Jørgensen SP, Wildt S, Graff J, Gregersen T, Zaremba A, Borup Andersen T, Nøjgaard C, Timm HB, Rainteau D, Hansen SH, Rumessen JJ, Munck LK (April 2023). "Efficacy and safety of colesevelam for the treatment of bile acid diarrhoea: a double-blind, randomised,
424:, absorption is less efficient (Type 3 bile acid malabsorption). A very small proportion of the patients with no obvious disease (Type 2 bile acid malabsorption) may have mutations in ASBT, but this mutation is not more common in most patients and does not affect function. 416:. These bile acid transporters are all highly expressed in the ileum but not in the liver, jejunum or colon. When expression of these specialized transporters is reduced, the intestine is less efficient at bile acid reabsorption (Type 1 bile acid malabsorption). If 481:
The various biomarkers give similar diagnostic yields of around 25% in patients with functional bowel disorders with diarrhea. In countries such as the US, where SeHCAT is not available, fecal bile acids and C4 are available to make the diagnosis.
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Wedlake, L; Thomas, K; Lalji, A; Anagnostopoulos, C; Andreyev, HJ (2009). "Effectiveness and tolerability of colesevelam hydrochloride for bile-acid malabsorption in patients with cancer: a retrospective chart review and patient questionnaire".
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Valentin, N; Camilleri, M; Altayar, O; Vijayvargiya, P; Acosta, A; Nelson, AD; Murad, MH (December 2016). "Biomarkers for bile acid diarrhoea in functional bowel disorder with diarrhoea: a systematic review and meta-analysis".
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Bile acid malabsorption is common in Crohn's disease but not always recognized. Most people with previous ileal resection and chronic diarrhea will have abnormal SeHCAT tests and can benefit from bile acid sequestrants.
556:, both in powder form, have been used for many years. Unfortunately, many patients find them difficult to tolerate; although the diarrhea may improve, other symptoms such as abdominal pain and bloating may worsen. 954:
Montagnani, M; Love, MW; Rössel, P; Dawson, PA; Qvist, P (2001). "Absence of dysfunctional ileal sodium-bile acid cotransporter gene mutations in patients with adult-onset idiopathic bile acid malabsorption".
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Brydon, WG; Nyhlin, H; Eastwood, MA; Merrick, MV (1996). "Serum 7 alpha-hydroxy-4-cholesten-3-one and selenohomocholyltaurine (SeHCAT) whole body retention in the assessment of bile acid induced diarrhoea".
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Walters JR, Johnston IM, Nolan JD, Vassie C, Pruzanski ME, Shapiro DA (January 2015). "The response of patients with bile acid diarrhoea to the farnesoid X receptor agonist obeticholic acid".
474:, (C4), a bile acid precursor, in serum, shows the increased bile acid synthesis found in bile acid malabsorption. This test is an alternative diagnostic means when available. Fasting blood 467:. This test is not licensed in the USA, and is underutilized even where it is available. Older methods such as the C-glycocholic breath test are no longer in routine clinical use. 2003:
Kårhus, M L; Brønden, A; Røder, M E (Aug 2019). "Remission of Bile Acid Malabsorption Symptoms Following Treatment With the Glucagon-Like Peptide 1 Receptor Agonist Liraglutide".
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Several methods have been developed to identify the disorder but there are difficulties with all of them. Diagnosis of bile acid malabsorption is easily and reliably made by the
2235: 1319:"Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome" 2739: 1839:"Colesevelam for the treatment of bile acid malabsorption-associated diarrhea in patients with Crohn's disease: A randomized, double-blind, placebo-controlled study" 217:. It has also been called bile acid-induced diarrhea, cholerheic or choleretic enteropathy, bile salt diarrhea or bile salt malabsorption. It can result from 2334: 588:
pathophysiological markers, suggesting it may be a new, safe and more effective treatment compared with current established, cheaper treatment modalities.
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van Tilburg, AJ; de Rooij, FW; van den Berg, JW; van Blankenstein, M (1992). "Primary bile acid malabsorption: a pathophysiologic and clinical entity?".
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Estimates of the population prevalence suggest that 1% of the adult population could have primary bile acid diarrhea (Type 2 bile acid malabsorption).
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with malabsorption. The synthesis of bile acids in the liver is negatively regulated by the ileal hormone fibroblast growth factor 19 (
2814: 2221: 1558:"Fibroblast growth factor 19 in patients with bile acid diarrhoea: a prospective comparison of FGF19 serum assay and SeHCAT retention" 3486: 3333: 3231: 1224:"Differences in Fecal Microbiomes and Metabolomes of People With vs Without Irritable Bowel Syndrome and Bile Acid Malabsorption" 494:. When other causes were recognized, and an idiopathic, primary form described, a classification into three types was proposed: 3523: 3372: 2984: 2967: 2472: 2467: 2344: 471: 140: 2497: 3226: 3182: 3076: 2898: 3437: 3283: 562:
is a tablet which is well tolerated and has been shown in placebo-controlled, randomized clinical trials to be effective.
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Beigel F, Teich N, Howaldt S, Lammert F, Maul J, Breiteneicher S, Rust C, Göke B, Brand S, Ochsenkühn T (November 2014).
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is another farnesoid X receptor agonist that has been studied, showing improvements in biochemistry and colonic transit.
3192: 2711: 2319: 907:"Primary bile acid malabsorption caused by mutations in the ileal sodium-dependent bile acid transporter gene (SLC10A2)" 337: 2406: 1418: 759:
Sadowski, DC; Camilleri, M; Chey, WD; Leontiadis, GI; Marshall, JK; Shaffer, EA; Tse, F; Walters, JRF (January 2020).
437:), and lower levels of this hormone result in overproduction of bile acids, which are more than the ileum can absorb. 2302: 2772: 2701: 3045: 3001: 2954: 2760: 2378: 509: 349: 3071: 1122:"Enterohepatic, Gluco-metabolic, and Gut Microbial Characterization of Individuals With Bile Acid Malabsorption" 1079:"Enterohepatic, Gluco-metabolic, and Gut Microbial Characterization of Individuals With Bile Acid Malabsorption" 3391: 2706: 2664: 2477: 2352: 2339: 2280: 2185: 601: 446:
Furthermore, gut microbiome composition differs from that of people who do not suffer from bile acid diarrhea.
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Walters, JR (2010). "Defining primary bile acid diarrhea: making the diagnosis and recognizing the disorder".
1165:"The pathophysiology of bile acid diarrhoea: differences in the colonic microbiome, metabolome and bile acids" 761:"Canadian Association of Gastroenterology Clinical Practice Guideline on the Management of Bile Acid Diarrhea" 713:
Vijayvargiya P, Camilleri M (March 2018). "Update on Bile Acid Malabsorption: Finally Ready for Prime Time?".
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Bile acid-induced diarrhea, cholerheic or choleretic enteropathy, bile salt diarrhea, bile salt malabsorption
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Pattni SS, Brydon WG, Dew T, Johnston IM, Nolan JD, Srinivas M, Basumani P, Bardhan KD, Walters JR (2013).
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of bile acids takes place 4–6 times in 24 hours and usually less than 0.5 g of bile acids enter the
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is often effective. It is recognised as a disability in the United Kingdom under the Equality Act 2010.
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Type 1: Bile acid malabsorption, secondary to ileal resection, or ileal inflammation (e.g. in
293: 130: 46: 3498: 3418: 3413: 3403: 3265: 3137: 3065: 2883: 2790: 2785: 2715: 2674: 2482: 2447: 2097: 2087: 2048: 2012: 1977: 1931: 1923: 1888: 1850: 1789: 1743: 1704: 1667: 1659: 1618: 1569: 1522: 1478: 1435: 1427: 1378: 1330: 1284: 1276: 1235: 1194: 1184: 1176: 1143: 1133: 1100: 1090: 1051: 1014: 964: 926: 918: 877: 867: 826: 782: 772: 722: 658: 648: 637:"How bad is bile acid diarrhoea: an online survey of patient-reported symptoms and outcomes" 570: 459: 51: 3456: 3386: 3252: 3187: 3152: 3023: 2888: 2824: 2726: 2645: 2636: 2586: 2526: 2411: 2388: 513: 365: 357: 353: 341: 329: 106: 2213: 2102: 2075: 1148: 1121: 1105: 1078: 3493: 3408: 2962: 2935: 2800: 2735: 2731: 2621: 2591: 1732:"Systematic review: the management of chronic diarrhoea due to bile acid malabsorption" 1672: 1647: 1440: 1413: 1289: 1264: 1199: 1164: 882: 855: 815:"Chronic diarrhea caused by idiopathic bile acid malabsorption: an explanation at last" 663: 636: 635:
Bannaga, A; Kelman, L; O'Connor, M; Pitchford, C; Walters, JR; Arasaradnam, RP (2017).
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values may have value in the recognition of the disease and prediction of response.
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transfer bile acids through and out of the cell where they eventually enter the
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Walters, JR; Tasleem, AM; Omer, O S; Brydon, WG; Dew, T; le Roux, CW (2009).
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People with primary bile acid diarrhea are frequently misdiagnosed as having
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is affected by gastro-intestinal surgery, or bile acids are deconjugated by
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Wedlake L, A'Hern R, Russell D, Thomas K, Walters JR, Andreyev HJ (2009).
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has shown clinical and biochemical benefits in a proof of concept study.
517: 405: 369: 262: 242: 214: 213:, is a cause of several gut-related problems, the main one being chronic 2136: 2893: 2659: 2563: 2535: 1265:"Methods for diagnosis of bile acid malabsorption in clinical practice" 409: 389: 385: 289: 281: 1981: 1927: 1748: 1731: 1574: 1557: 1382: 922: 831: 814: 505:
Type 2: Idiopathic bile acid malabsorption, Primary bile acid diarrhea
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about leaving home (primarily due to fear of fecal incontinence),
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Bowel movement frequency, soft or watery stools, diarrhea, urgency
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and other gastrointestinal symptoms such as abdominal swelling,
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abnormal retention and an increasing likelihood of response to
245:, with watery or mushy, unformed stools, (types 6 and 7 on the 1695:
Fromm, H; Malavolti, M (1986). "Bile acid-induced diarrhoea".
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Surgical Pathology of Non-neoplastic Gastrointestinal Diseases
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Bile acid malabsorption was first recognized in patients with
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are the main agents used to treat bile acid malabsorption.
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per 24 h. When larger amounts of bile acids enter the
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KĂĄrhus, M L; Ellegaard, A; Winther-Jensen, M (Dec 2023).
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Khalid, U; Lalji, A; Stafferton, R; Andreyev, J (2010).
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Zhang, Lizhi; Chandan, Vishal S.; Wu, Tsung-Teh (2019).
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Vijayvargiya P, Camilleri M, Shin A, Saenger A (2013).
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People with this disorder often report impairments of
225:, or be a primary disorder, associated with excessive 1515:
European Journal of Gastroenterology & Hepatology
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Oelkers, P; Kirby, LC; Heubi, JE; Dawson, PA (1997).
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Scandinavian Journal of Gastroenterology. Supplement
3472: 3358: 3351: 3292: 3206: 3163: 3009: 3000: 2953: 2907: 2862: 2748: 2635: 2525: 2512: 2387: 2261: 2252: 2130: 2076:"The Epidemiology of Bile Acid Diarrhea in Denmark" 348:and are taken up by the liver and resecreted. This 192: 184: 174: 162: 146: 129: 113: 101: 93: 85: 77: 67: 57: 45: 37: 32: 1371:Expert Review of Gastroenterology & Hepatology 819:Expert Review of Gastroenterology & Hepatology 1414:"Bile acid malabsorption: a forgotten diagnosis?" 1463: 1461: 1459: 1312: 1310: 1308: 808: 806: 754: 752: 630: 628: 626: 624: 384:is very efficient at absorbing the glyco- and 2229: 2041:The Lancet. Gastroenterology & Hepatology 1881:The Lancet. Gastroenterology & Hepatology 1879:placebo-controlled, phase 4 clinical trial". 390:apical sodium-dependent bile salt transporter 8: 2335:Esophagogastric junction outflow obstruction 33:Bile acid diarrhea / Bile acid malabsorption 328:and are released after meals stimulated by 3355: 3006: 2522: 2374:Esophageal intramural pseudodiverticulosis 2258: 2236: 2222: 2214: 2127: 1970:Alimentary Pharmacology & Therapeutics 29: 2101: 2091: 1935: 1854: 1747: 1671: 1622: 1573: 1439: 1364: 1362: 1334: 1288: 1239: 1198: 1188: 1147: 1137: 1104: 1094: 1018: 930: 881: 871: 830: 786: 776: 662: 652: 388:-conjugated forms of the bile salts. The 1730:Wilcox C, Turner J, Green J (May 2014). 1007:Clinical Gastroenterology and Hepatology 957:Scandinavian Journal of Gastroenterology 765:Clinical Gastroenterology and Hepatology 97:Primary or secondary or types 1, 2 and 3 620: 305:Enterohepatic circulation of bile salts 1817:"Bile acid malabsorption: colesevelam" 257:are common manifestations, often with 2602:Small intestinal bacterial overgrowth 996: 994: 911:The Journal of Clinical Investigation 522:small intestinal bacterial overgrowth 422:small intestinal bacterial overgrowth 404:) and the basolateral heterodimer of 360:, they stimulate water secretion and 253:, increased frequency and urgency of 124:small intestinal bacterial overgrowth 7: 854:Dawson, PA; Lan, T; Rao, A (2009). 376:Intestinal absorption of bile acids 368:, which causes symptoms of chronic 241:A persistent (chronic) history of 25: 3487:Spontaneous bacterial peritonitis 3334:Exocrine pancreatic insufficiency 2039:non-inferiority clinical trial". 1646:Thaysen, EH; Pedersen, L (1976). 89:Chronic (longlasting, persistent) 3534:Gastrointestinal tract disorders 3232:Secondary sclerosing cholangitis 1648:"Idiopathic bile acid catharsis" 1527:10.1097/00042737-199602000-00005 1336:10.1111/j.1365-2036.2009.04081.x 715:Current Gastroenterology Reports 441:Dysmetabolism and gut microbiome 2473:Gastric antral vascular ectasia 2468:Portal hypertensive gastropathy 2345:Gastroesophageal reflux disease 1794:10.1016/j.clinthera.2009.11.027 398:ileal bile acid binding protein 3227:Primary sclerosing cholangitis 3077:Hepatic veno-occlusive disease 2899:Solitary rectal ulcer syndrome 1: 3284:Sphincter of Oddi dysfunction 2053:10.1016/S2468-1253(22)00198-4 1893:10.1016/S2468-1253(22)00401-0 1709:10.1016/S0300-5089(21)00739-2 1624:10.1016/S0016-5085(67)80140-9 1432:10.7861/clinmedicine.10-2-124 508:Type 3: Secondary to various 332:. They are important for the 105:Surgical resection of ileum, 3539:Steatorrhea-related diseases 3193:Postcholecystectomy syndrome 2712:Intestinal pseudoobstruction 2320:Esophageal motility disorder 2017:10.1053/j.gastro.2019.04.002 1856:10.1016/j.crohns.2014.05.009 1269:Clin. Gastroenterol. Hepatol 1241:10.1053/j.gastro.2019.11.301 1139:10.1016/j.gastha.2021.12.007 1096:10.1016/j.gastha.2021.12.007 472:7α-Hydroxy-4-cholesten-3-one 428:Overproduction of bile acids 229:production. Treatment with 141:7α-hydroxy-4-cholesten-3-one 1697:Clinics in Gastroenterology 1163:Sagar, NM (November 2020). 813:Hofmann AF (October 2009). 654:10.1136/bmjgast-2016-000116 73:Anxiety, fecal incontinence 3555: 3178:Gallstone / Cholelithiasis 2702:Functional colonic disease 2498:Zollinger–Ellison syndrome 1483:10.1136/gutjnl-2015-309889 1222:Jeffery, IB (March 2020). 1181:10.1038/s41598-020-77374-7 969:10.1080/003655201750422693 873:10.1194/jlr.R900012-JLR200 400:(IBABP, ILBP, gene symbol 2379:Acute esophageal necrosis 1281:10.1016/j.cgh.2013.04.029 1056:10.3109/00365529209096030 1020:10.1016/j.cgh.2009.04.024 860:Journal of Lipid Research 778:10.1016/j.cgh.2019.08.062 727:10.1007/s11894-018-0615-z 692:. Springer. p. 226. 641:BMJ Open Gastroenterology 510:gastrointestinal diseases 392:(ASBT, IBAT, gene symbol 350:enterohepatic circulation 2478:Gastric dumping syndrome 2353:Laryngopharyngeal reflux 2340:Diffuse esophageal spasm 1916:Aliment. Pharmacol. Ther 1815:NICE (29 October 2013). 1736:Aliment. Pharmacol. Ther 1562:Aliment. Pharmacol. Ther 1323:Aliment. Pharmacol. Ther 856:"Bile acid transporters" 602:irritable bowel syndrome 340:of fats (lipids) in the 223:gastrointestinal disease 153:Irritable bowel syndrome 120:Pelvic radiation disease 3094:Alcoholic liver disease 2627:Bile acid malabsorption 2571:Peptic (duodenal) ulcer 203:Bile acid malabsorption 3524:Diseases of intestines 3104:Hepatic encephalopathy 2488:Buried bumper syndrome 2419:Peptic (gastric) ulcer 2303:Mallory–Weiss syndrome 2246:human digestive system 585:GLP-1 receptor agonist 546:Bile acid sequestrants 465:bile acid sequestrants 316:) are produced in the 231:bile acid sequestrants 188:1 in 100 of population 169:Bile acid sequestrants 148:Differential diagnosis 3329:Pancreatic pseudocyst 3198:Porcelain gallbladder 2310:Zenker's diverticulum 1782:Clinical Therapeutics 1664:10.1136/gut.17.12.965 526:radiation enteropathy 3133:Hepatorenal syndrome 3072:Budd–Chiari syndrome 3029:Autoimmune hepatitis 2854:Intestinal adhesions 2612:Short bowel syndrome 2441:Functional dyspepsia 2359:Esophageal stricture 2325:Nutcracker esophagus 2093:10.2147/CLEP.S442054 1605:Hofmann, AF (1967). 567:farnesoid X receptor 534:chronic pancreatitis 320:, secreted into the 3272:Choledocholithiasis 3143:Metabolic disorders 3109:Acute liver failure 3082:Portal hypertension 3034:Alcoholic hepatitis 2877:Radiation proctitis 2796:Mesenteric ischemia 2768:Gastroenterocolitis 2597:Blind loop syndrome 2407:MĂ©nĂ©trier's disease 2315:Barrett's esophagus 1234:(4): 1016–1028.e8. 1126:Gastro Hep Advances 1120:KĂĄrhus, ML (2022). 1083:Gastro Hep Advances 1077:KĂĄrhus, ML (2022). 418:intestinal motility 362:intestinal motility 247:Bristol stool scale 180:Good with treatment 157:microscopic colitis 3447:Undefined location 3438:Grynfeltt–Lesshaft 3339:Pancreatic fistula 3322:Pancreatic abscess 3277:Biliary dyskinesia 3248:Mirizzi's syndrome 2749:Large and/or small 2429:Dieulafoy's lesion 2298:Boerhaave syndrome 259:fecal incontinence 249:), sometimes with 237:Signs and symptoms 211:bile acid diarrhea 135:Fecal bile acids, 18:Bile acid diarrhea 3511: 3510: 3507: 3506: 3347: 3346: 2949: 2948: 2806:Bowel obstruction 2508: 2507: 2211: 2210: 1982:10.1111/apt.15967 1928:10.1111/apt.12999 1749:10.1111/apt.12684 1575:10.1111/apt.12466 1477:(12): 1951–1959. 1419:Clinical Medicine 1383:10.1586/egh.10.54 923:10.1172/JCI119355 832:10.1586/egh.09.49 699:978-3-030-15573-5 209:), known also as 200: 199: 131:Diagnostic method 27:Medical condition 16:(Redirected from 3546: 3499:Pneumoperitoneum 3356: 3266:Common bile duct 3148:Wilson's disease 3138:Peliosis hepatis 3007: 2884:Proctalgia fugax 2791:Abdominal angina 2716:Ogilvie syndrome 2665:Pseudomembranous 2523: 2483:Gastric volvulus 2448:Pyloric stenosis 2259: 2244:Diseases of the 2238: 2231: 2224: 2215: 2128: 2116: 2115: 2105: 2095: 2071: 2065: 2064: 2035: 2029: 2028: 2005:Gastroenterology 2000: 1994: 1993: 1964: 1958: 1957: 1939: 1911: 1905: 1904: 1875: 1869: 1868: 1858: 1843:J Crohns Colitis 1834: 1828: 1827: 1825: 1823: 1812: 1806: 1805: 1776: 1770: 1769: 1751: 1727: 1721: 1720: 1692: 1686: 1685: 1675: 1643: 1637: 1636: 1626: 1611:Gastroenterology 1602: 1596: 1595: 1577: 1553: 1547: 1546: 1509: 1503: 1502: 1465: 1454: 1453: 1443: 1409: 1403: 1402: 1366: 1357: 1356: 1338: 1314: 1303: 1302: 1292: 1260: 1254: 1253: 1243: 1228:Gastroenterology 1219: 1213: 1212: 1202: 1192: 1160: 1154: 1153: 1151: 1141: 1117: 1111: 1110: 1108: 1098: 1074: 1068: 1067: 1039: 1033: 1032: 1022: 998: 989: 988: 951: 945: 944: 934: 902: 896: 895: 885: 875: 851: 845: 844: 834: 810: 801: 800: 790: 780: 756: 747: 746: 710: 704: 703: 683: 677: 676: 666: 656: 632: 571:obeticholic acid 460:nuclear medicine 324:, stored in the 52:Gastroenterology 30: 21: 3554: 3553: 3549: 3548: 3547: 3545: 3544: 3543: 3514: 3513: 3512: 3503: 3468: 3457:Internal hernia 3343: 3288: 3253:Biliary fistula 3211: 3202: 3188:Adenomyomatosis 3183:Cholesterolosis 3159: 3153:Hemochromatosis 3024:Viral hepatitis 2996: 2945: 2903: 2889:Rectal prolapse 2858: 2825:Fecal impaction 2815:Intussusception 2778:Crohn's disease 2744: 2727:Toxic megacolon 2639: 2637:Large intestine 2631: 2576:Curling's ulcer 2529: 2527:Small intestine 2516: 2504: 2412:Gastroenteritis 2383: 2248: 2242: 2212: 2207: 2206: 2139: 2125: 2120: 2119: 2073: 2072: 2068: 2047:(10): 922–931. 2037: 2036: 2032: 2002: 2001: 1997: 1966: 1965: 1961: 1913: 1912: 1908: 1877: 1876: 1872: 1836: 1835: 1831: 1821: 1819: 1814: 1813: 1809: 1788:(11): 2549–58. 1778: 1777: 1773: 1729: 1728: 1724: 1694: 1693: 1689: 1645: 1644: 1640: 1604: 1603: 1599: 1555: 1554: 1550: 1511: 1510: 1506: 1467: 1466: 1457: 1411: 1410: 1406: 1368: 1367: 1360: 1316: 1315: 1306: 1262: 1261: 1257: 1221: 1220: 1216: 1162: 1161: 1157: 1119: 1118: 1114: 1076: 1075: 1071: 1041: 1040: 1036: 1013:(11): 1189–94. 1000: 999: 992: 963:(10): 1077–80. 953: 952: 948: 904: 903: 899: 866:(12): 2340–57. 853: 852: 848: 812: 811: 804: 771:(1): 24–41.e1. 758: 757: 750: 712: 711: 707: 700: 685: 684: 680: 634: 633: 622: 617: 594: 543: 514:cholecystectomy 500:Crohn's disease 488: 470:Measurement of 452: 443: 430: 378: 358:large intestine 354:large intestine 342:small intestine 330:cholecystokinin 307: 302: 239: 107:cholecystectomy 28: 23: 22: 15: 12: 11: 5: 3552: 3550: 3542: 3541: 3536: 3531: 3526: 3516: 3515: 3509: 3508: 3505: 3504: 3502: 3501: 3496: 3494:Hemoperitoneum 3491: 3490: 3489: 3478: 3476: 3470: 3469: 3467: 3466: 3465: 3464: 3459: 3454: 3443: 3442: 3441: 3440: 3435: 3422: 3421: 3416: 3411: 3406: 3401: 3400: 3399: 3394: 3383: 3382: 3377: 3376: 3375: 3364: 3362: 3353: 3349: 3348: 3345: 3344: 3342: 3341: 3336: 3331: 3326: 3325: 3324: 3319: 3314: 3309: 3298: 3296: 3290: 3289: 3287: 3286: 3281: 3280: 3279: 3274: 3261: 3260: 3255: 3250: 3241: 3240: 3239: 3234: 3229: 3218: 3216: 3204: 3203: 3201: 3200: 3195: 3190: 3185: 3180: 3175: 3169: 3167: 3161: 3160: 3158: 3157: 3156: 3155: 3150: 3140: 3135: 3130: 3129: 3128: 3123: 3113: 3112: 3111: 3106: 3096: 3091: 3090: 3089: 3084: 3079: 3074: 3062: 3061: 3060: 3050: 3049: 3048: 3038: 3037: 3036: 3031: 3026: 3015: 3013: 3004: 2998: 2997: 2995: 2994: 2993: 2992: 2982: 2981: 2980: 2975: 2965: 2963:Blood in stool 2959: 2957: 2951: 2950: 2947: 2946: 2944: 2943: 2938: 2936:Anal dysplasia 2933: 2928: 2923: 2913: 2911: 2905: 2904: 2902: 2901: 2896: 2891: 2886: 2881: 2880: 2879: 2868: 2866: 2860: 2859: 2857: 2856: 2851: 2850: 2849: 2839: 2838: 2837: 2827: 2822: 2817: 2812: 2803: 2801:Angiodysplasia 2798: 2793: 2782: 2781: 2780: 2770: 2765: 2764: 2763: 2752: 2750: 2746: 2745: 2743: 2742: 2736:Diverticulosis 2732:Diverticulitis 2729: 2720: 2719: 2718: 2709: 2699: 2694: 2693: 2692: 2687: 2682: 2677: 2672: 2667: 2657: 2651: 2649: 2633: 2632: 2630: 2629: 2624: 2622:Milroy disease 2619: 2614: 2609: 2604: 2599: 2594: 2592:Tropical sprue 2589: 2580: 2579: 2578: 2568: 2567: 2566: 2561: 2556: 2545: 2543: 2520: 2514:Lower GI tract 2510: 2509: 2506: 2505: 2503: 2502: 2501: 2500: 2490: 2485: 2480: 2475: 2470: 2465: 2460: 2455: 2450: 2445: 2444: 2443: 2433: 2432: 2431: 2426: 2416: 2415: 2414: 2409: 2404: 2393: 2391: 2385: 2384: 2382: 2381: 2376: 2371: 2366: 2361: 2356: 2350: 2349: 2348: 2342: 2337: 2332: 2327: 2317: 2312: 2307: 2306: 2305: 2300: 2290: 2289: 2288: 2283: 2278: 2267: 2265: 2256: 2254:Upper GI tract 2250: 2249: 2243: 2241: 2240: 2233: 2226: 2218: 2209: 2208: 2205: 2204: 2193: 2182: 2171: 2156: 2140: 2135: 2134: 2132: 2131:Classification 2124: 2123:External links 2121: 2118: 2117: 2080:Clin Epidemiol 2066: 2030: 2011:(2): 569–571. 1995: 1976:(5): 808–820. 1959: 1906: 1887:(4): 321–331. 1870: 1849:(11): 1471–9. 1829: 1807: 1771: 1722: 1687: 1658:(12): 965–70. 1638: 1597: 1548: 1504: 1455: 1404: 1358: 1304: 1275:(10): 1232–9. 1255: 1214: 1155: 1132:(3): 299-312. 1112: 1089:(3): 299-312. 1069: 1034: 990: 946: 897: 846: 802: 748: 705: 698: 678: 647:(1): e000116. 619: 618: 616: 613: 593: 590: 550:Cholestyramine 542: 539: 538: 537: 530:celiac disease 506: 503: 487: 486:Classification 484: 451: 448: 442: 439: 429: 426: 377: 374: 322:biliary system 306: 303: 301: 298: 267:abdominal pain 238: 235: 198: 197: 194: 190: 189: 186: 182: 181: 178: 172: 171: 166: 160: 159: 150: 144: 143: 133: 127: 126: 117: 111: 110: 103: 99: 98: 95: 91: 90: 87: 83: 82: 79: 75: 74: 71: 65: 64: 61: 55: 54: 49: 43: 42: 39: 35: 34: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 3551: 3540: 3537: 3535: 3532: 3530: 3527: 3525: 3522: 3521: 3519: 3500: 3497: 3495: 3492: 3488: 3485: 3484: 3483: 3480: 3479: 3477: 3475: 3471: 3463: 3460: 3458: 3455: 3453: 3450: 3449: 3448: 3445: 3444: 3439: 3436: 3434: 3431: 3430: 3429: 3428: 3424: 3423: 3420: 3417: 3415: 3412: 3410: 3407: 3405: 3402: 3398: 3395: 3393: 3390: 3389: 3388: 3385: 3384: 3381: 3378: 3374: 3371: 3370: 3369: 3368:Diaphragmatic 3366: 3365: 3363: 3361: 3357: 3354: 3350: 3340: 3337: 3335: 3332: 3330: 3327: 3323: 3320: 3318: 3315: 3313: 3310: 3308: 3305: 3304: 3303: 3300: 3299: 3297: 3295: 3291: 3285: 3282: 3278: 3275: 3273: 3270: 3269: 3268: 3267: 3263: 3262: 3259: 3256: 3254: 3251: 3249: 3245: 3242: 3238: 3235: 3233: 3230: 3228: 3225: 3224: 3223: 3220: 3219: 3217: 3215: 3209: 3205: 3199: 3196: 3194: 3191: 3189: 3186: 3184: 3181: 3179: 3176: 3174: 3173:Cholecystitis 3171: 3170: 3168: 3166: 3162: 3154: 3151: 3149: 3146: 3145: 3144: 3141: 3139: 3136: 3134: 3131: 3127: 3124: 3122: 3119: 3118: 3117: 3116:Liver abscess 3114: 3110: 3107: 3105: 3102: 3101: 3100: 3099:Liver failure 3097: 3095: 3092: 3088: 3085: 3083: 3080: 3078: 3075: 3073: 3070: 3069: 3068: 3067: 3063: 3059: 3056: 3055: 3054: 3051: 3047: 3044: 3043: 3042: 3039: 3035: 3032: 3030: 3027: 3025: 3022: 3021: 3020: 3017: 3016: 3014: 3012: 3008: 3005: 3003: 2999: 2991: 2988: 2987: 2986: 2983: 2979: 2976: 2974: 2971: 2970: 2969: 2966: 2964: 2961: 2960: 2958: 2956: 2952: 2942: 2939: 2937: 2934: 2932: 2929: 2927: 2924: 2922: 2918: 2915: 2914: 2912: 2910: 2906: 2900: 2897: 2895: 2892: 2890: 2887: 2885: 2882: 2878: 2875: 2874: 2873: 2870: 2869: 2867: 2865: 2861: 2855: 2852: 2848: 2845: 2844: 2843: 2840: 2836: 2833: 2832: 2831: 2828: 2826: 2823: 2821: 2818: 2816: 2813: 2811: 2807: 2804: 2802: 2799: 2797: 2794: 2792: 2788: 2787: 2783: 2779: 2776: 2775: 2774: 2771: 2769: 2766: 2762: 2759: 2758: 2757: 2756:Enterocolitis 2754: 2753: 2751: 2747: 2741: 2737: 2733: 2730: 2728: 2724: 2721: 2717: 2713: 2710: 2708: 2705: 2704: 2703: 2700: 2698: 2695: 2691: 2688: 2686: 2683: 2681: 2678: 2676: 2673: 2671: 2668: 2666: 2663: 2662: 2661: 2658: 2656: 2653: 2652: 2650: 2647: 2643: 2638: 2634: 2628: 2625: 2623: 2620: 2618: 2615: 2613: 2610: 2608: 2605: 2603: 2600: 2598: 2595: 2593: 2590: 2588: 2584: 2583:Malabsorption 2581: 2577: 2574: 2573: 2572: 2569: 2565: 2562: 2560: 2557: 2555: 2552: 2551: 2550: 2547: 2546: 2544: 2541: 2537: 2533: 2528: 2524: 2521: 2519: 2515: 2511: 2499: 2496: 2495: 2494: 2491: 2489: 2486: 2484: 2481: 2479: 2476: 2474: 2471: 2469: 2466: 2464: 2461: 2459: 2458:Gastroparesis 2456: 2454: 2451: 2449: 2446: 2442: 2439: 2438: 2437: 2434: 2430: 2427: 2425: 2424:Cushing ulcer 2422: 2421: 2420: 2417: 2413: 2410: 2408: 2405: 2403: 2400: 2399: 2398: 2395: 2394: 2392: 2390: 2386: 2380: 2377: 2375: 2372: 2370: 2369:Megaesophagus 2367: 2365: 2362: 2360: 2357: 2354: 2351: 2346: 2343: 2341: 2338: 2336: 2333: 2331: 2328: 2326: 2323: 2322: 2321: 2318: 2316: 2313: 2311: 2308: 2304: 2301: 2299: 2296: 2295: 2294: 2291: 2287: 2284: 2282: 2279: 2277: 2274: 2273: 2272: 2269: 2268: 2266: 2264: 2260: 2257: 2255: 2251: 2247: 2239: 2234: 2232: 2227: 2225: 2220: 2219: 2216: 2203: 2199: 2198: 2194: 2192: 2188: 2187: 2183: 2181: 2177: 2176: 2172: 2170: 2166: 2165: 2161: 2157: 2155: 2151: 2150: 2146: 2142: 2141: 2138: 2133: 2129: 2122: 2113: 2109: 2104: 2099: 2094: 2089: 2086:: 1173–1181. 2085: 2081: 2077: 2070: 2067: 2062: 2058: 2054: 2050: 2046: 2042: 2034: 2031: 2026: 2022: 2018: 2014: 2010: 2006: 1999: 1996: 1991: 1987: 1983: 1979: 1975: 1971: 1963: 1960: 1955: 1951: 1947: 1943: 1938: 1937:10044/1/21617 1933: 1929: 1925: 1921: 1917: 1910: 1907: 1902: 1898: 1894: 1890: 1886: 1882: 1874: 1871: 1866: 1862: 1857: 1852: 1848: 1844: 1840: 1833: 1830: 1818: 1811: 1808: 1803: 1799: 1795: 1791: 1787: 1783: 1775: 1772: 1767: 1763: 1759: 1755: 1750: 1745: 1742:(9): 923–39. 1741: 1737: 1733: 1726: 1723: 1718: 1714: 1710: 1706: 1703:(3): 567–82. 1702: 1698: 1691: 1688: 1683: 1679: 1674: 1669: 1665: 1661: 1657: 1653: 1649: 1642: 1639: 1634: 1630: 1625: 1620: 1616: 1612: 1608: 1601: 1598: 1593: 1589: 1585: 1581: 1576: 1571: 1568:(8): 967–76. 1567: 1563: 1559: 1552: 1549: 1544: 1540: 1536: 1532: 1528: 1524: 1521:(2): 117–23. 1520: 1516: 1508: 1505: 1500: 1496: 1492: 1488: 1484: 1480: 1476: 1472: 1464: 1462: 1460: 1456: 1451: 1447: 1442: 1437: 1433: 1429: 1425: 1421: 1420: 1415: 1408: 1405: 1400: 1396: 1392: 1388: 1384: 1380: 1376: 1372: 1365: 1363: 1359: 1354: 1350: 1346: 1342: 1337: 1332: 1329:(7): 707–17. 1328: 1324: 1320: 1313: 1311: 1309: 1305: 1300: 1296: 1291: 1286: 1282: 1278: 1274: 1270: 1266: 1259: 1256: 1251: 1247: 1242: 1237: 1233: 1229: 1225: 1218: 1215: 1210: 1206: 1201: 1196: 1191: 1190:10044/1/87396 1186: 1182: 1178: 1174: 1170: 1166: 1159: 1156: 1150: 1145: 1140: 1135: 1131: 1127: 1123: 1116: 1113: 1107: 1102: 1097: 1092: 1088: 1084: 1080: 1073: 1070: 1065: 1061: 1057: 1053: 1049: 1045: 1038: 1035: 1030: 1026: 1021: 1016: 1012: 1008: 1004: 997: 995: 991: 986: 982: 978: 974: 970: 966: 962: 958: 950: 947: 942: 938: 933: 928: 924: 920: 917:(8): 1880–7. 916: 912: 908: 901: 898: 893: 889: 884: 879: 874: 869: 865: 861: 857: 850: 847: 842: 838: 833: 828: 824: 820: 816: 809: 807: 803: 798: 794: 789: 788:10044/1/76745 784: 779: 774: 770: 766: 762: 755: 753: 749: 744: 740: 736: 732: 728: 724: 720: 716: 709: 706: 701: 695: 691: 690: 682: 679: 674: 670: 665: 660: 655: 650: 646: 642: 638: 631: 629: 627: 625: 621: 614: 612: 609: 605: 603: 598: 591: 589: 586: 582: 578: 576: 572: 568: 563: 561: 557: 555: 551: 547: 540: 535: 531: 527: 523: 519: 515: 511: 507: 504: 501: 497: 496: 495: 493: 492:ileal disease 485: 483: 479: 477: 473: 468: 466: 461: 457: 449: 447: 440: 438: 436: 427: 425: 423: 419: 415: 411: 407: 403: 399: 395: 391: 387: 383: 375: 373: 371: 367: 363: 359: 355: 351: 347: 343: 339: 335: 331: 327: 323: 319: 315: 312:(also called 311: 304: 299: 297: 295: 291: 287: 283: 279: 275: 274:mental health 270: 268: 264: 260: 256: 252: 248: 244: 236: 234: 232: 228: 224: 221:secondary to 220: 219:malabsorption 216: 212: 208: 204: 195: 191: 187: 183: 179: 177: 173: 170: 167: 165: 161: 158: 154: 151: 149: 145: 142: 138: 134: 132: 128: 125: 121: 118: 116: 112: 108: 104: 100: 96: 92: 88: 84: 80: 76: 72: 70: 69:Complications 66: 62: 60: 56: 53: 50: 48: 44: 40: 36: 31: 19: 3446: 3425: 3302:Pancreatitis 3264: 3214:biliary tree 3087:Nutmeg liver 3064: 2990:Hematochezia 2941:Pruritus ani 2926:Anal abscess 2921:Anal fistula 2917:Anal fissure 2830:Constipation 2784: 2655:Appendicitis 2626: 2463:Gastroptosis 2453:Achlorhydria 2292: 2281:Eosinophilic 2195: 2184: 2173: 2158: 2143: 2083: 2079: 2069: 2044: 2040: 2033: 2008: 2004: 1998: 1973: 1969: 1962: 1922:(1): 54–64. 1919: 1915: 1909: 1884: 1880: 1873: 1846: 1842: 1832: 1820:. Retrieved 1810: 1785: 1781: 1774: 1739: 1735: 1725: 1700: 1696: 1690: 1655: 1651: 1641: 1617:(4): 752–7. 1614: 1610: 1600: 1565: 1561: 1551: 1518: 1514: 1507: 1474: 1470: 1426:(2): 124–6. 1423: 1417: 1407: 1377:(5): 561–7. 1374: 1370: 1326: 1322: 1272: 1268: 1258: 1231: 1227: 1217: 1175:(1): 20436. 1172: 1168: 1158: 1129: 1125: 1115: 1086: 1082: 1072: 1047: 1043: 1037: 1010: 1006: 960: 956: 949: 914: 910: 900: 863: 859: 849: 825:(5): 461–4. 822: 818: 768: 764: 718: 714: 708: 688: 681: 644: 640: 610: 606: 599: 595: 592:Epidemiology 579: 564: 558: 544: 489: 480: 469: 458:test. This 453: 444: 431: 401: 393: 379: 308: 300:Pathogenesis 280:, including 271: 240: 210: 206: 202: 201: 115:Risk factors 109:, idiopathic 3482:Peritonitis 3244:Cholestasis 3222:Cholangitis 3165:Gallbladder 3053:Fatty liver 2973:Hematemesis 2955:GI bleeding 2761:Necrotizing 2690:Lymphocytic 2685:Collagenous 2680:Microscopic 2617:Steatorrhea 2518:Enteropathy 2364:Inlet patch 2286:Herpetiform 2271:Esophagitis 581:Liraglutide 560:Colesevelam 414:portal vein 326:gallbladder 251:steatorrhea 78:Usual onset 38:Other names 3518:Categories 3474:Peritoneal 3452:Incisional 3373:Congenital 3317:Hereditary 3294:Pancreatic 3258:Haemobilia 2931:Hemorrhoid 2909:Anal canal 2847:Infectious 2835:Functional 2670:Ulcerative 2554:Duodenitis 2493:Gastrinoma 2197:DiseasesDB 615:References 575:Tropifexor 554:colestipol 512:including 338:absorption 314:bile salts 310:Bile acids 294:depression 278:well-being 255:defecation 164:Medication 3462:Richter's 3419:Spigelian 3414:Obturator 3404:Umbilical 3237:Ascending 3208:Bile duct 3041:Cirrhosis 3019:Hepatitis 3002:Accessory 2872:Proctitis 2723:Megacolon 2697:Dysentery 2607:Whipple's 2559:Jejunitis 2549:Enteritis 2436:Dyspepsia 2397:Gastritis 2330:Achalasia 2263:Esophagus 1822:17 August 1050:: 66–70. 985:218908622 721:(3): 10. 541:Treatment 450:Diagnosis 334:digestion 286:dizziness 227:bile acid 196:Non-fatal 185:Frequency 176:Prognosis 47:Specialty 3529:Diarrhea 3392:Indirect 3387:Inguinal 3121:Pyogenic 3066:Vascular 2842:Diarrhea 2820:Volvulus 2786:Vascular 2725: / 2714: / 2675:Ischemic 2642:Appendix 2532:Duodenum 2402:Atrophic 2276:Candidal 2112:38089008 2103:10712339 2061:35868334 2025:30965026 1990:32702169 1954:44661338 1946:25329562 1901:36758570 1865:24953836 1802:20109999 1766:12016216 1758:24602022 1584:23981126 1543:23867181 1491:26347530 1450:20437979 1399:27123642 1391:20932141 1353:11327665 1345:19570102 1299:23644387 1250:31843589 1209:33235223 1149:11307667 1106:11307667 1029:19426836 977:11589382 892:19498215 841:19817666 797:31526844 735:29582208 673:28123771 569:agonist 518:vagotomy 370:diarrhea 263:bloating 243:diarrhea 215:diarrhea 86:Duration 59:Symptoms 3433:Petit's 3409:Femoral 3312:Chronic 3126:Amoebic 2894:Anismus 2660:Colitis 2587:Coeliac 2564:Ileitis 2536:Jejunum 2389:Stomach 2293:Rupture 2191:C567652 1717:3742841 1682:1017717 1673:1411224 1633:5337211 1592:6386339 1535:8723414 1499:3454888 1441:4952080 1290:3783593 1200:7686486 1169:Sci Rep 1064:1298051 941:9109432 883:2781307 743:4419631 664:5253456 394:SLC10A2 386:taurine 364:in the 290:anxiety 282:fatigue 81:Any age 3427:Lumbar 3397:Direct 3380:Hiatus 3360:Hernia 3212:Other 2978:Melena 2864:Rectum 2347:(GERD) 2180:613291 2110:  2100:  2059:  2023:  1988:  1952:  1944:  1899:  1863:  1800:  1764:  1756:  1715:  1680:  1670:  1631:  1590:  1582:  1541:  1533:  1497:  1489:  1448:  1438:  1397:  1389:  1351:  1343:  1297:  1287:  1248:  1207:  1197:  1146:  1103:  1062:  1027:  983:  975:  939:  932:508012 929:  890:  880:  839:  795:  741:  733:  696:  671:  661:  536:, etc. 456:SeHCAT 193:Deaths 137:SeHCAT 102:Causes 3352:Other 3307:Acute 3058:MASLD 3011:Liver 2985:Lower 2968:Upper 2810:Ileus 2646:Colon 2540:Ileum 2355:(LPR) 2169:579.8 2154:K90.8 1950:S2CID 1762:S2CID 1588:S2CID 1539:S2CID 1495:S2CID 1395:S2CID 1349:S2CID 981:S2CID 739:S2CID 476:FGF19 435:FGF19 402:FABP6 382:ileum 366:colon 346:ileum 318:liver 94:Types 2740:SCAD 2202:6650 2186:MeSH 2175:OMIM 2164:9-CM 2108:PMID 2057:PMID 2021:PMID 1986:PMID 1942:PMID 1897:PMID 1861:PMID 1824:2014 1798:PMID 1754:PMID 1713:PMID 1678:PMID 1629:PMID 1580:PMID 1531:PMID 1487:PMID 1446:PMID 1387:PMID 1341:PMID 1295:PMID 1246:PMID 1205:PMID 1060:PMID 1025:PMID 973:PMID 937:PMID 888:PMID 837:PMID 793:PMID 731:PMID 694:ISBN 669:PMID 583:, a 565:The 552:and 410:OSTβ 408:and 406:OSTα 380:The 336:and 276:and 265:and 3046:PBC 2773:IBD 2707:IBS 2160:ICD 2145:ICD 2098:PMC 2088:doi 2049:doi 2013:doi 2009:157 1978:doi 1932:hdl 1924:doi 1889:doi 1851:doi 1790:doi 1744:doi 1705:doi 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Index

Bile acid diarrhea
Specialty
Gastroenterology
Symptoms
Complications
cholecystectomy
Risk factors
Pelvic radiation disease
small intestinal bacterial overgrowth
Diagnostic method
SeHCAT
7α-hydroxy-4-cholesten-3-one
Differential diagnosis
Irritable bowel syndrome
microscopic colitis
Medication
Bile acid sequestrants
Prognosis
diarrhea
malabsorption
gastrointestinal disease
bile acid
bile acid sequestrants
diarrhea
Bristol stool scale
steatorrhea
defecation
fecal incontinence
bloating
abdominal pain

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