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Comprehensive Guide to Bile Acid Malabsorption : Causes, Symptoms, & Effective Treatments

Bile acid malabsorption is a condition characterized by the improper absorption of bile acids in the intestines. Bile acids, produced in the liver, are crucial for the emulsification and absorption of dietary fats. When malabsorption occurs, it can lead to a series of adverse digestive symptoms. This article explores the causes, symptoms, and treatments for bile acid malabsorption, providing a comprehensive view of this under-diagnosed condition.

Causes of Bile Acid Malabsorption

Bile acid malabsorption can occur due to several reasons, which include: 

  1. Primary Bile Acid Diarrhea

This condition is idiopathic, meaning the exact cause is unknown. It is thought to occur when there’s an overproduction of bile acids in the liver.

  1. Secondary Bile Acid Malabsorption

This typically occurs due to an underlying disease or surgical intervention which affects the functioning of the ileum, where bile acids are usually absorbed. Conditions can include:

  • Ileal Resection: Removal of a portion of the ileum, often as a treatment for diseases like Crohn’s.
  • Radiation Therapy: Can cause damage to the ileum affecting bile acid absorption.
  • Celiac Disease: May affect the ileum’s ability to absorb bile acids efficiently.
  1. Chronic Diseases

Chronic liver diseases or pancreatitis can alter bile production and its flow, leading to malabsorption.

  1. Other Causes of Bile Acid Malabsorption

  • Short bowel syndrome: This is a condition in which the small intestine is too short to absorb nutrients properly. BAM is a common complication of short bowel syndrome.
  • Parasitic infection: Intestinal parasites can damage the small intestine and make it difficult for bile acids to be absorbed.
  • Certain medications: Some medications, such as antibiotics and proton pump inhibitors, can increase the risk of BAM.

Symptoms of Bile Acid Malabsorption

Bile acid malabsorption can lead to a range of symptoms, primarily affecting the gastrointestinal system. Some of the main symptoms include:

  • Chronic Diarrhea: Frequent loose, watery stools are a primary symptom.
  • Bloating and Abdominal Pain: Due to malabsorption and increased colonic motility.
  • Fecal Incontinence: Difficulty in controlling bowel movements.
  • Fat Malabsorption: Leading to steatorrhea, where stools contain high levels of fat.
  • Nutrient Deficiencies: Poor absorption of fat-soluble vitamins like A, D, E, and K.
  • Weight Loss: Chronic malabsorption can lead to significant weight loss over time.
  • Steatorrhea (fatty stools)
  • Itching around the anus
  • Lightheadedness
  • Fatigue

Treatments of Bile Acid Malabsorption

Management and treatment of bile acid malabsorption aim to alleviate symptoms and restore normal bowel function. The treatments might involve 

  1. Dietary Adjustments for Bile Acid Malabsorption

  • Low-Fat Diet: Reducing dietary fat can sometimes help in managing symptoms.
  • Soluble Fiber: Incorporating soluble fiber into the diet can help absorb excess bile acid.
  • Avoiding Irritants: Steering clear of alcohol and caffeine, which can exacerbate symptoms.
  1. Medications to Treat Bile Acid Malabsorption

  • Bile Acid Sequestrants: Drugs like cholestyramine, colestipol, or colesevelam can bind to bile acids in the intestines, preventing them from causing diarrhea.
  • Antidiarrheal Agents: Medications like loperamide can help control diarrhea.
  1. Vitamin Supplementation

Since malabsorption can lead to vitamin deficiencies, supplementation of fat-soluble vitamins may be recommended.

  1. Treating Underlying Causes of Bile Acid Malabsorption

Addressing the underlying causes like Crohn’s disease or celiac disease can sometimes help in managing bile acid malabsorption. 

  1. Surgery

In severe cases, surgery might be recommended to address any structural issues in the gastrointestinal tract.

  1. Individualized Treatment Plans

Treatment often requires a personalized approach, taking into account the specific causes and symptoms experienced by the individual.

Outlook for Bile Acid Malabsorption

The outlook for bile acid malabsorption is generally good. With treatment, most people can manage their symptoms and live a normal life. However, BAM can be a chronic condition, and symptoms may come and go.

If you are experiencing symptoms of bile acid malabsorption, it is important to see a doctor for diagnosis and treatment. Early diagnosis and treatment can help to improve your symptoms and prevent complications.

Here are some additional tips for managing bile acid malabsorption:


Bile acid malabsorption, although not commonly diagnosed, can significantly impact an individual’s quality of life due to its disruptive gastrointestinal symptoms. Understanding the potential causes and recognizing the symptoms are vital steps in obtaining appropriate treatment. With the right approach, it is possible to manage the condition effectively, alleviating symptoms and enhancing life quality. If you suspect you have bile acid malabsorption, consult with a healthcare provider to discuss potential treatment options.


  1. Johnston, I., & Nolan, J. (2017). Bile Acid Diarrhoea and FGF19: New Views on Diagnosis, Pathogenesis and Therapy. Nature Reviews Gastroenterology & Hepatology, 14(7), 454-464.
  2. Walters, J.R., & Pattni, S.S. (2010). Managing Bile Acid Diarrhoea. Therapeutic Advances in Gastroenterology, 3(6), 349-357.
  3. Camilleri, M., & Sellin, J.H. (2015). Bile Acid Diarrhea: Pathophysiology and Treatment. Gastroenterology, 149(6), 1483-1496.e2.
  4. Beigel, F., & Teich, N. (2017). Bile Acid Malabsorption in Inflammatory Bowel Disease. Inflammatory Bowel Diseases, 23(3), 395-400.
  5. Vijayvargiya, P., & Camilleri, M. (2019). Bile Acid Synthesis, Metabolism and Function in Liver and Gut: Implications for Treating Bile Acid Diarrhoea. Digestive Diseases, 37(5), 377-384.
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:September 11, 2023

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