It is natural for symptoms of two conditions to overlap, but after proper diagnosis of the same, determining the treatment path becomes easy. However, there are some conditions that possess uncannily similar symptoms– while this itself is a challenge, the absence of adequate diagnostic tests makes the dilemma a lot more concerning.
One such confusing pair is that of Bile Acid Malabsorption (BAM) and Irritable Bowel Syndrome (IBS). It is an often-overlooked condition that shares symptoms with the latter, making diagnosis challenging. According to research, nearly one-third of IBS patients could be misdiagnosed and may actually be suffering from BAM. We at OnlyMyHealth connected with Dr. Piyush Ranjan, Vice-Chairperson, Institute Of Liver Gastroenterology & Pancreatico Biliary Sciences to understand the same.
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What Is Bile Acid Malabsorption?
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Bile acid malabsorption (BAM) is a condition that affects the digestive system. It frequently results in persistent diarrhoea. Bile acids accumulate in your intestines when they are not adequately absorbed, disrupting the internal chemical equilibrium.
Dr Ranjan explains that bile acids are produced in the liver and help digest fats. After aiding digestion, they are reabsorbed in the terminal ileum (part of the small intestine) and return to the liver through a process called enterohepatic circulation. When this process is disrupted due to overproduction of bile acids or issues in the ileum, bile acids leak into the large intestine, causing diarrhoea and other symptoms.
Types Of Bile Acid Malabsorption
According to Dr Ranjan, BAM is classified into types 1, 2, 3, and 4 based on its mechanism:
Type 1: Due to ileal disease or resection.
Type 2: Related to idiopathic causes.
Type 3: Associated with other gastrointestinal disorders.
Type 4: Medication-induced or due to bile acid overproduction.
Why Does Bile Acid Malabsorption Go Unnoticed?
It is an often-overlooked condition that shares symptoms with irritable bowel syndrome (IBS), making diagnosis challenging. According to Dr Ranjan, nearly one-third of IBS patients could be misdiagnosed and may actually be suffering from BAM.
To add to this pre-existing issue, diagnosing BAM is complicated because gold-standard tests, like the SeHCAT test and faecal bile acid measurement, are often unavailable in many countries, including India. Other diagnostic methods, such as measuring serum C4 levels, are also limited.
How Does Bile Acid Malabsorption Get Confused With IBS And 8 Hidden Signs
Both BAM and IBS share symptoms like diarrhoea and abdominal pain, but the underlying causes differ. BAM is caused by bile acid dysregulation, while IBS is a functional disorder with no structural cause.
- Watery diarrhoea.
- Regular bowel movements.
- Unpleasant cramping in the stomach.
- Urgency and trouble suppressing bowel motions.
- Some individuals also possess:
- Bloating of the abdomen.
- Gas and pain from gas.
- Steatorrhea (tummy faeces)
How Is BAM Diagnosed?
Diagnosing BAM is a challenge because the necessary tests are often unavailable. For instance:
- The 75SeHCAT test, a gold-standard radionuclide-based test, is not accessible in India.
- Measurement of C4 enzyme levels in the blood and faecal bile acid tests are also difficult to find.
- This lack of diagnostic tools makes clinical suspicion crucial for identifying BAM.
Treatment Options For Those With BAM
Despite diagnostic challenges, BAM can often be managed effectively. The most common treatment is a bile acid sequestrant, such as cholestyramine. This drug binds excess bile acids in the intestine, reducing diarrhoea and related symptoms. Cholestyramine is available in sachet form and can also be used as a diagnostic aid; if symptoms improve after taking it, BAM is likely.
In cases where BAM is linked to another intestinal disorder, addressing the root cause (e.g., treating Crohn’s disease) can help alleviate symptoms.
Key Takeaway
If you have IBS-like symptoms, particularly persistent diarrhoea and abdominal discomfort, consider the possibility of BAM. While diagnostic tests remain limited, clinical suspicion and simple treatments like bile acid sequestrants can provide relief and improve quality of life.