Bile Acid Deficiency - Causes, Symptoms, and Management

Introduction:

Bile acid deficiency, commonly known as bile acid malabsorption, is a condition that primarily affects the bile acids in the intestines. Bile is an important component produced in the liver and stored in the gallbladder. It is essential for digesting the required nutrients from the diet.

What Is Bile?

Bile is the fluid that is released by the liver and gets collected and stored in the gallbladder. It is an important fluid that aids in dissolving fatty acids into soluble fats, which can be transferred to the digestive tract. Bile contains the following components:

• Cholesterol.

• Bile acids.

• Bilirubin.

• Water.

• Copper.

• Body salts like sodium and potassium.

How Is Bile Produced in the Body?

Bile is produced by the liver, which plays a crucial role in the digestion process. The release of bile involves the following steps:

• Hepatocytes are primarily involved in bile production. Within this cell, the cholesterol, bilirubin, and bile salts are synthesized.

• The breakdown of hemoglobin, a major component of red blood cells, produces bilirubin.

• After the bile is secreted, it moves further into small channels called the bile canaliculi.

• Later it gets continuously produced by the liver and is stored in higher concentration in the gallbladder.

• When an individual consumes food, the gallbladder contracts and releases the stored bile.

What Are Bile Acids?

Bile acids are formed by the liver while it filters the blood. It is a waste product formed by toxins, excess cholesterol, and dead blood cells. The various acids in bile enable it to stabilize the lipids and keep them in a liquid state.

The liver sends bile through bile ducts into the small intestine, where it gets digested. These bile acids in the small intestine aid with the breakdown of fat for absorption. Once this process is over, they are automatically reabsorbed into circulation and finally delivered, where they are recycled again.

What Is Bile Acid Deficiency?

The impaired absorption of bile acids in the intestine is called bile acid deficiency or bile acid diarrhea. Normally, the bile acids get released into the small intestine and are broken down into fats and aid with the absorption of dietary fat. However, in the case of bile acid deficiency, the reabsorption of bile acid is usually poor and leads to an increased loss of bile acids in stools.

Who Is Affected by Bile Acid Deficiency?

Individuals diagnosed with functional diarrhea are highly susceptible to bile acid deficiency. They do not have any apparent cause and are likely to be detected during the medical examination. The disorder can be observed in the following conditions,

• Microscopic colitis.

• Crohn's disease.

• Diarrhea.

• HIV-related enteritis.

• Pancreatic deficiency.

• Due to surgical bypass of the ileum.

• Gallbladder removal.

• Radiation therapy.

• Chemotherapy.

What Are the Symptoms of Bile Acid Deficiency?

Some of the symptoms of bile acid deficiency are mentioned below:

• Diarrhea.

• Stomach cramps.

• Abdominal bloating.

• Gas.

• Fatty stools or steatorrhea.

• Indigestion.

• Dehydration.

• Fatigue.

• Dizziness.

• Nausea.

What Causes Bile Acid Deficiency?

Bile acid deficiency or bile acid diarrhea is due to various factors disrupting the absorption of bile acids, and some of the common causes are discussed below:

• Gastrointestinal surgery, like removal or bypassing of the ileum, where the bile acids are most likely reabsorbed, can result in bile acid deficiency.

• Gastrointestinal disorders like Crohn’s disease, which is a chronic inflammatory bowel disease involving any part of the gastrointestinal tract.

• Celiac disease is a medical condition that occurs due to gluten consumption and can damage the lining of the small intestine.

• An increased overgrowth of bacteria could interfere with bile acid absorption.

• Certain medications could interfere with bile acid absorption.

• Abdominal radiation therapy can be used in cancer treatment, which damages the small intestine lining.

• Certain bile acid metabolism can contribute to bile acid deficiency.

How Is Bile Acid Deficiency Diagnosed?

Bile acid deficiency is diagnosed through a series of tests and assessments. A healthcare professional evaluates the underlying symptoms and causes to confirm the deficiency. The diagnostic process is mentioned below:

• The healthcare provider may take a thorough medical history of the condition and note down the duration and symptoms. In addition, they may also perform a physical examination to identify any signs of malabsorption and gastric issues.

• A stool sample analysis may be done to understand the fat content and analyze it. Increased fat excretion in sool is a characteristic feature of bile acid deficiency. The inability to absorb bile acids could affect fat digestion.

• In addition, a 24-hour fecal bile acid assessment is done to identify the levels of bile acid excreted in the stool. Low levels are indicative of bile acid malabsorption.

• Blood tests may also be performed to identify deficiencies in the fat-soluble vitamins and nutrients resulting from bile acid deficiency.

What Is the Management of Bile Acid Deficiency?

Managing bile acid deficiency involves dietary modification and medications to improve symptoms and improve quality of life. The primary goals are to reduce diarrhea and address any underlying causes of bile acid absorption. Some of the methods involved in bile acid deficiency management are mentioned below:

• Reducing fat intake helps to relieve symptoms of diarrhea and decreases the quantity of fat required to be digested by the body.

• Eating more frequent meals may help to reduce the volume of food quantity stored in the intestine and aid with the easy processing and digestion of food.

• Avoiding foods that worsen the symptom can be highly useful.

• Medications can be prescribed to enhance bile acid absorption and reduce the symptoms caused by poor absorption.

• The medication works by increasing the reabsorption of bile acids in the intestines and helping to restore the bile acids to improve fat digestion.

• Frequent follow-ups are required to manage the symptoms and treatment effectiveness.

Conclusion:

Therefore, bile acid deficiency is caused due to impairment in the absorption of bile acids in the intestine. The condition could be caused due to various factors like underlying medical conditions or certain types of drugs. Bile acid deficiency is usually seen as watery diarrhea and abdominal pain. Altering the diet and taking specific medication can help to restore normal functions and improve the quality of life.