Bile acid malabsorption: colesevelam

What is bile acid malabsorption?

Bile is essential for us to digest fats that we eat. When we eat, bile is released from the gall bladder into the small intestine where fats are broken down and absorbed into the body. Normally most of the bile is then reabsorbed from the small intestine and recycled, with only a small amount reaching the large intestine (colon), where it is removed in the stools.

People with problems reabsorbing bile acid (bile acid malabsorption) have more bile than normal in the colon. This extra bile makes the colon release more water and speeds up the time it takes for waste to pass through the colon. This results in chronic watery diarrhoea.

Bile acid malabsorption is found in a number of conditions. For example, it can be caused by diseases of the small intestine, such as Crohn's disease, and it is seen in people who have had an operation to remove or bypass their small intestine. However, sometimes it occurs when the small bowel appears normal; the reason for bile acid malabsorption in this situation is not known.

Although not life threatening, bile acid malabsorption can have a big effect on lifestyle and quality of life because the increased need to pass motions may limit the person's ability to travel and leave the house.