19th July 2023

Bile Acid Malabsorption (BAM)

BAM is a chronic condition caused by failed reabsorption of bile in the terminal ileum and subsequent accumulation in the colon, where it stimulates water and electrolyte secretion. It can be idiopathic or occur secondary to ileal dysfunction (resection or Crohn’s disease), coeliac disease, pancreatic insufficiency, bacterial overgrowth or following cholecystectomy. BAM presents with chronic non-bloody greasy pungent diarrhoea. It can be diagnosed using the selenium homocholic acid taurine (SeHCAT) test, however, this is no longer recommended by NICE. Other tests that aid diagnosis include a trial of treatment – 48-hour total stool bile acid levels or fasting C4 levels. The mainstay of treatment is implementing a low-fat diet and oral bile acid binders – most commonly cholestyramine.