Up to a third of those diagnosed with Irritable Bowel Syndrome (IBS) Diarrhoea may have Bile Acit Malabsorption (BAM).Bile Acid Malabsorption or Diarrhoea (BAM) is a cause of chronic diarrhoea with the patients having their bowels open several times a day. There can be a number of reasons why patients get this condition and these have been placed in to three types:
- Type 1: Bile acid malabsorption, secondary to ileal resection, or ileal inflammation
- Crohn’s disease, ileal resections
- Type 2: Idiopathic / primary bile acid malabsorption
- Type 3: Secondary to various gastrointestinal diseases
- Cholecystectomy, small intestinal bacterial overgrowth, post radiation, coeliac disease, chronic pancreatitis
Bile salts are made in your liver. When you eat a meal, especially if it has fat in it, these bile salts are released from your liver and gall bladder (if you still have one) into your upper intestine (duodenum). They help to digest the food as it travels through your small bowel. When the bile salts reach the far end of your small bowel, they are mostly absorbed back into your body and travel back in the blood stream to your liver. They are stored here until they are needed for the next meal.
There is one specific area of the small bowel which is responsible for absorbing these bile salts. If this area becomes diseased or has been removed at surgery or damaged, for example by radiotherapy, it may not be possible for enough of the bile salts to be absorbed back into your body. If, as a result of failed absorption, too much bile salt reaches your lower intestine (colon), bile salt will cause fluid to be pumped into your colon by your body, which will cause diarrhoea (loose or watery stools).
How will bile salt malabsorption affect me?
Diarrhoea can lead to a need to get to the toilet urgently. Sometimes, this diarrhoea can be pale and greasy looking. Bile salt malabsorption may also cause cramp-like pains in your abdomen. These can be very severe. You may also suffer from very smelly wind and very erratic bowel movements. Very occasionally, if too much bile salt is lost, sufferers start to lose weight. This is because they do not have enough bile salts to help digest their food properly. Untreated bile salt malabsorption can increase your risk of forming gallstones and kidney stones.
Vitamin B12 is another vital nutrient which is absorbed into the body at the end of the small bowel. If this area of the bowel is not working properly, people with bile salt malabsorption may also become short of vitamin B12. This can make them feel tired and short of breath.
What is the treatment for bile salt malabsorption?
There are a number of treatments which may help the symptoms caused by bile salt malabsorption. It can take several days before diarrhoea starts to improve. It often takes several weeks for smelly wind to settle.
You should keep taking the medicines for ten days before deciding they do not work. If you stop sooner, you may not have given them enough time. It is very unlikely that having had a diagnosis of bile salt malabsorption that it will improve without treatment, this treatment will likely continue for the rest of your life. If the treatment is effective and you stop it or run out of medicines, your symptoms will almost certainly return either immediately or within a few days.
Once medication is taken it allows the acids to be clumped together and then excreted and prevents it from having such an effect of the bowel. There are a few different choices of medication available and patients will need to continue on the medication for their lifetime.
Diagnosing BAM
A SeHCAT scan is most commonly used to confirm the diagnosis of BAM. This scan involves 2 scans one week apart. The patient will be given a tablet to swallow which has bile acids in. These acids can be measured when the patient returns for the second scan and the percentage of acids remaining gives an indication as to whether the patient has the condition or not. The typical range is above 15% = Normal, below 15% = signals excessive bile acid loss.
Once the scans have been reviewed the patient will receive a follow up appointment and given information regarding the scan results.
Understanding BAM
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