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New Insights into Bile Acid Malabsorption

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Abstract

Bile acid malabsorption occurs when there is impaired absorption of bile acids in the terminal ileum, so interrupting the normal enterohepatic circulation. The excess bile acids in the colon cause diarrhea, and treatment with bile acid sequestrants is beneficial. The condition can be diagnosed with difficulty by measuring fecal bile acids, or more easily by retention of selenohomocholyltaurine (SeHCAT), where this is available. Chronic diarrhea caused by primary bile acid diarrhea appears to be common, but is under-recognized where SeHCAT testing is not performed. Measuring excessive bile acid synthesis with 7α-hydroxy-4-cholesten-3-one may be an alternative means of diagnosis. It appears that there is no absorption defect in primary bile acid diarrhea but, instead, an overproduction of bile acids. Fibroblast growth factor 19 (FGF19) inhibits hepatic bile acid synthesis. Defective production of FGF19 from the ileum may be the cause of primary bile acid diarrhea.

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Acknowledgment

The authors express their gratitude to the Broad Foundation and to the Bardhan Research and Education Trust for supporting their research.

Disclosure

Ian Johnston has received a grant from Bardhan Research and Education Trust; Julian RF Walters has received grants from the Broad Foundation and Bardhan Research and Education Trust, and has served as an advisory board member for GE Healthcare; Jonathan Nolan and Sanjeev S. Pattni reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Section of Hepatology & Gastroenterology, Department of Medicine, Imperial College London, Du Cane Road, London, W12 0HS, UK

    Ian Johnston, Jonathan Nolan, Sanjeev S. Pattni & Julian R. F. Walters

  2. Imperial College Healthcare, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK

    Ian Johnston, Jonathan Nolan, Sanjeev S. Pattni & Julian R. F. Walters

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  1. Ian Johnston
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  2. Jonathan Nolan
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  3. Sanjeev S. Pattni
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Correspondence to Julian R. F. Walters.

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Johnston, I., Nolan, J., Pattni, S.S. et al. New Insights into Bile Acid Malabsorption. Curr Gastroenterol Rep 13, 418–425 (2011). https://doi.org/10.1007/s11894-011-0219-3

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