MODERN VIEWS ON BILE ACID DIARRHEA
DOI:
https://doi.org/10.11603/1681-2727.2019.3.10635Keywords:
bile acid diarrhea, exchange of bile acid, 75SeHCAT-test, treatment of diarrheaAbstract
The purpose of the work is to summarize data on etiology, mechanism of development, clinical manifestations, laboratory diagnostics and principles of treatment of bile acid diarrhea (BAD). BAD – chronic diarrhea, caused by excessive bile acid (BA) in the colon.
Most often BAD arises due to a violation of absorption of BA in the small intestine, with rapid transit of BA due to increased motor and evacuation function of the small intestine.
The article presents the main mechanisms of the exchange of BA in the normal and at different pathological conditions. Violation of absorption of BA in the small intestine may be primary (congenital) – most often with celiac disease and secondary. Secondary disturbed absorption of BA develops in patients after resection of the ileum or with acute inflammatory diseases (Crohn’s disease).
Development of BAD can be due to the pathology of the biliary system. Excessive absorption of bile in the intestine is possible after cholecystectomy or with biliary dyskinesia, with Oddi sphincter dysfunction syndrome.
The main symptom of BAD is frequent feces of a liquid consistency of bright yellow or green color. Another characteristic symptom of BAD is pain in the right abdomen.
In the basis of the diagnostic algorithm of BAD, in addition to collecting the history and detail of patient complaints, there is a study of feces and performance a number of specific tests: 75SeHCAT-test, determination of the level of serum metabolite C4 (7a-hydroxy-4-cholesten-3-one) and the concentration of fibroblast growth factor FGF-19.
BAD treatment includes diet correction and symptomatic therapy. Assign enterosorbents, with pain syndrome – antispasmodic. To eliminate the asynchronous intake of bile into the small intestine during meals prescribe choleretic drugs, for the treatment of excessive bacterial growth syndrome in the upper small intestine prescribed intestinal antibiotics, intestinal antiseptics, probiotics and prebiotics. In the period of severe diarrhea, prescribe drugs that suppress peristalsis, in particular loperamide. With significant loss of liver function with feces, the use of sequestrants of bile (cholestyramine) is recommended.
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