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Primary bile acid diarrhea (Type 2 bile acid "malabsorption") may be caused by an overproduction of bile acids. [ 5 ] [ 9 ] Several groups of workers have failed to show any defect in ileal bile acid absorption in these patients, and they have an enlarged bile acid pool, rather than the reduced pool expected with malabsorption. [ 10 ]
Chronic diarrhea in postcholecystectomy syndrome is a type of bile acid diarrhea (type 3). [3] This can be treated with a bile acid sequestrant like cholestyramine, [3] colestipol [2] or colesevelam, [7] which may be better tolerated. [8]
When bile enters the duodenum (the first part of the small intestine), it aids in digesting the fat within food leaving the stomach. When the bile can not be properly propelled from the not-mechanically-obstructed gallbladder or can not flow out of the end of the common bile duct properly, there is a state of biliary dyskinesia.
In addition, unabsorbed fatty acids, converted to hydroxy-fatty acids by colonic flora, as well as unabsorbed bile acids both impair absorption and induce secretion of water and electrolytes by the colon adding to stool mass. Weight loss is common among patients with significant intestinal malabsorption but must be evaluated in the context of ...
Persons with short bowel syndrome may have complications caused by malabsorption of vitamins and minerals, such as deficiencies in vitamins A, D, E, K, B 9 (folic acid), and B 12, calcium, magnesium, iron, and zinc. These may appear as anemia, hyperkeratosis (scaling of the skin), easy bruising, muscle spasms, poor blood clotting, and bone pain.
Bile acids also have hormonal actions throughout the body, particularly through the farnesoid X receptor and GPBAR1 (also known as TGR5). [7] Bile acid synthesis is the only manner in which humans or other mammals may excrete excess cholesterol, as the parent compound of all bile acids is cholesterol. [citation needed]
Bypassing the major site of bile acid reabsorption in the small intestine therefore further reduces fat and fat-soluble vitamin absorption. As a result, huge amounts of fatty acids , which are normally absorbed in the small intestine, enter the colon, where they cause irritation of the colon wall and the secretion of excessive volumes of water ...
PSC is characterized by inflammation of the bile ducts (cholangitis) with consequent stricturing (i.e., narrowing) and hardening of these ducts due to scar formation, be it inside and/or outside the liver. [18] The resulting scarring of the bile ducts obstructs the flow of bile, which further perpetuates bile duct and liver injury.