The failure to adequately absorb bile acids in the terminal ileum can result in a malabsorption syndrome.
Clinical features:
(1) The patient has a history of a disorder associated with bile acid malabsorption.
(2) The patient has a watery diarrhea.
(3) Some patients may experience nocturnal diarrhea.
(4) There is laboratory evidence of bile acid malabsorption, such as a low retention of selenium homocholic acid taurine (SeHCAT) (< 15%) retention at 7 days.
(5) Therapy with cholestyramine (or other bile acid binder) results in clinical improvement.
Because laboratory testing to document bile acid malabsorption may not be available clinicians may use a trial of therapy with a bile acid binder.
Differential diagnosis:
(1) other forms of malabsorption
(2) irritable bowel syndrome (IBS)
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