Excessive delivery of bile salts to certain parts of the bowel (usually the colon) can trigger a secretory diarrhea.


Clinical features:

(1) secretory diarrhea

(2) exclusion of other causes of diarrhea

(3) presence of a condition associated with bile salt diarrhea (see below)

(4) correction by use of bile sequestration resin or by correction of cause of excessive bile salt delivery


Conditions associated with a defect in the terminal ileum and managed by bile sequestration:

(1) Crohn's disease

(2) ileal resection

(3) radiation enteritis


Conditions associated with an intact terminal ileum and maneged by bile sequestration:

(1) post-cholecystectomy

(2) hereditary defect in ileal absorption of bile salts associated with SLC10A2 mutation


Conditions associated with intact terminal ileum and managed by correction of cause:

(1) drug-induced with chenodeoxycholic acid or ursodeoxycholic acid: treat by reducing the dose

(2) cholecystocolic fistula: treat by taking down the fistula

(3) possibly bacterial overgrowth: treat with broad spectrum oral antibiotics and/or bile salt sequestration


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