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Management of chronic diarrhea due to bile acid malabsorption

The latest issue of Alimentary Pharmacology & Therapeutics investigates the management of chronic diarrhea due to bile acid malabsorption.

News image

Bile acid malabsorption is a common, yet under-recognized, cause of chronic diarrhea, with limited guidance available on the appropriate management of patients with bile acid malabsorption.

Dr Green and colleagues from the United Kingdom summarized the evidence supporting different treatments available for patients with bile acid malabsorption, noting their impact on clinical outcomes, tolerability and associated side effects.

The researchers performed a literature search through PubMed, the Cochrane Database of Systematic Reviews and Scopus.

Relevant articles studied patients who had been diagnosed with bile acid malabsorption and were clinically assessed before and after therapy.

The team identified a total of 30 relevant publications, which investigated the clinical response to drugs, including colestyramine, colestipol, colesevelam, aluminium hydroxide and obeticholic acid.

The most commonly used diagnostic test of bile acid malabsorption was the SeHCAT test.

Colestyramine treatment was successful in 70% of patients
Alimentary Pharmacology & Therapeutics

The research team noted that colestyramine treatment was by far the most studied of these agents, and was successful in 70% of 801 patients.

Dr Green's team concludes, "Colestyramine and colestipol are generally effective treatments of gastrointestinal symptoms from bile acid malabsorption, but may be poorly tolerated and reduce the bioavailability of co-administered agents."

"Alternative therapies (including colesevelam and aluminium hydroxide) as well as dietary intervention may also have a role, and the promising results of the first proof-of-concept study of obeticholic acid suggest that its novel approach may have an exciting future in the treatment of this condition."

"Future trials should employ accurate diagnostic testing and be conducted over longer periods so that the long-term benefits and tolerability of these different approaches can be evaluated."

Aliment Pharmacol Ther  2014: 39(9): 923–939
08 April 2014

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