Update on Bile Acid Malabsorption: Finally Ready for Prime Time?

Curr Gastroenterol Rep. 2018 Mar 26;20(3):10. doi: 10.1007/s11894-018-0615-z.


Purpose of review: To provide an update on the prevalence, pathophysiology, disease associations, and treatment options for bile acid malabsorption (BAM).

Recent findings: •Molecular mechanisms-BAs prevent water reabsorption and increase water secretion by intracellular mediators, increasing aquaporin channels and intracellular permeability. •Inflammatory bowel disease-new molecular mechanisms of BAM are identified in patients without ileal disease, including changes in expression of ileal BA transporter and nuclear receptors involved in BA homeostasis. •Microscopic colitis-BAM is one of the mechanisms leading to microscopic colitis. •Diagnostic testing-new diagnostic tests have been launched in the USA (serum C4 and fecal 48-h BA excretion); stimulated FGF19 has higher detection of BAM compared to fasting sample alone. •Treatment-investigational FXR agonists may provide a daily, oral option for treatment of BAM instead of BA sequestrants. There is a greater appreciation of the biological role of bile acids across multiple fields of medicine, including gastrointestinal indications.

Keywords: Bile acid malabsorption; Colonic mechanisms; FXR agonists; Fibroblast growth factor; Inflammatory bowel disease; Microscopic colitis.

Publication types

  • Review

MeSH terms

  • Bile Acids and Salts / metabolism*
  • Bile Acids and Salts / physiology
  • Biomarkers / blood
  • Cholecystectomy / adverse effects
  • Diarrhea / etiology
  • Diarrhea / physiopathology
  • Feces / chemistry
  • Humans
  • Inflammatory Bowel Diseases / complications
  • Malabsorption Syndromes / diagnosis*
  • Malabsorption Syndromes / epidemiology
  • Malabsorption Syndromes / physiopathology
  • Malabsorption Syndromes / therapy*
  • Radiation Injuries / etiology
  • Receptors, Cytoplasmic and Nuclear / agonists
  • Sequestering Agents / therapeutic use
  • Steatorrhea / etiology
  • Steatorrhea / physiopathology
  • Taurocholic Acid / analogs & derivatives


  • Bile Acids and Salts
  • Biomarkers
  • Receptors, Cytoplasmic and Nuclear
  • Sequestering Agents
  • farnesoid X-activated receptor
  • Taurocholic Acid
  • 23-seleno-25-homotaurocholic acid

Supplementary concepts

  • Bile Acid Malabsorption, Primary