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Gluten & Dairy
BAD Research Update 1
This is the first of a series of research updated on BAD for BAM support UK. To begin with, the title – BAM or BAD. Until recently, it has been commonly accepted that this condition related to a malabsorption of bile acids. Hence the term bile acid malabsorption. But more recent evidence would suggest that a proportion of patients do not actually malabsorb hence the preferred term ‘bile acid diarrhoea (BAD)’. Increasingly it will also be referred to as ‘primary’ where no obvious cause is found and ‘secondary’ where there is reason to develop this e.g. following an operation of the small bowel for Crohn’s disease as an example.
The link with those with IBS diarrhoea is important. Not until the seminal publication by Professor Bardhan’s group in 2000 (Smith et al.) did the wider medical community appreciate that up to a third of those diagnosed with IBS diarrhoea could actually have bile acid diarrhoea. Currently, the accepted test to diagnose BAD involves a nuclear medicine test called the SeHCAT test. NICE are currently undertaking a review of this, specifically the evidence to support its use. Newer tests are emerging that involve blood testing for an important regulatory hormone called FGF-
Apart from the importance of obtaining the correct diagnosis and minimising patient discomfort, BAD is treatable. The vast majority respond to a combination of low fat diet and sequestrants (Colestyramine, Colesevelam). Like most medications, there are side effects but the tablets, Colesevelam, are better tolerated although they are unfortunately not licensed for this condition. There is hope for newer therapies on the horizon – Obeticholic acid (Walters et al) which may bring hope to patients with BAD.