Bile Acid Diarrhea, Stepchild of Chronic Diarrhea - Prevalence, Diagnosis and Treatment

Die chologene Diarrho ist eine der haufigsten nicht diagnostizierten Ursachen der chronischen Diarrho, der zahlreiche verschiedene Pathophysiologien zugrunde liegen konnen. Auch nach Ausschlussdiagnostik der haufigeren Ursachen verbleiben bis zu 5% der Bevolkerung von einer ungeklarten chronischen Diarrho betroffen. In diesem Kollektiv findet sich in bis zu 50% als Ursache eine chologene Diarrho. Abstract The various pathophysiologies leading to bile acid diarrhea are well characterized. In this way, bile acid diarrhea can be divided into primary, secondary and tertiary subtypes. Common to all causes is the increased amount of bile acids in the colon and in the faeces and the resulting secretory-osmotic diarrhea, in more severe forms in combination with steatorrhea. The diagnosis of bile acid diarrhea follows a clear algorithm which, in addition to the search for the cause and possibly a therapeutic trial, recognizes the (75) SeHCAT test as the reference method for the detection of an increased loss of bile acids. In view of the chronic nature of the symptoms and the need for permanent, lifelong therapy, the use of a one-time, reliable diagnostic test is justified, though the test is currently only available at a few centers. In addition to the treatment of identifiable underlying diseases, the current treatment includes the use of drugs that bind bile acids, with additional nutritional recommendations and vitamin substitutions. The present review article summarizes the pathophysiology and importance of bile acid diarrhea and discusses the current approach towards diagnosis and treatment.