Bile acid diarrhea 

Causes

1. Type-1:  terminal ileal disease- crohn’s disease, terminal ileal resection
2. Type-2: Primary/idiopathic- no anatomical abnormality or risk factor
3. Type-3 : other condition affecting GI absorption- chronic pancreatitis, celiac disease, SIBO

Features

1. Urgent watery diarrhea ——————→due to impaired bile salt absorption
2. Steatorrhea / fat malabsorption ———→due to impaired micelle formation
3. Vit-B12 malabsorption 
4. Gallstones ———————————→ decreased bile salt pool, lithogenic bile
5. Oxalate renal calculi ———————-→ increased oxalate absorption from colon

Investigation:

1. 1. Contrast study

• Test for vit -B12

• S. Vit-B12 assay, Schilling test

• Test for bile acid malabsorption 

• SeHCAT (Se-homocholic acid taurine)
• S. 7a hydroxy cholestenone 

• Diagnostic trial of bile acid sequestrant 

• cholestyramine, colesevelam 

Treatment 

• Bile acid sequestrant – cholestyramine, colesevelam 
• Treatment of underlying causes if any.