DDSEP® 8 Quick Quiz

November 2016 Quiz 1

A 44-year-old woman with no significant history presents for an evaluation of an 8-month history of meal-triggered diarrhea. Physical examination is normal. Thyroid function panel, celiac serology, C-reactive protein, lactose breath testing, stool studies for infectious pathogens, enterography imaging, and colonoscopy with biopsies are all negative. Trial of loperamide is not helpful. She is started on a bile acid sequestrant with prompt resolution of symptoms.

Which of the following is true of the underlying etiology of this patient’s symptoms?

This is suggestive of type 1 bile acid diarrhea (BAD).

This is suggestive of type 2 BAD.

This is suggestive of type 3 BAD.

BAD is present in up to 50% of patient presenting with chronic watery diarrhea.

Q1: Answer: B

Rationale: Bile acid diarrhea (BAD) is becoming more widely recognized as a cause of chronic diarrhea. There are four associated types of BAD: Type 1 BAD is associated with ileal dysfunction with impaired reabsorption; type 2 BAD is considered primary or idiopathic BAD and occurs in the absence of ileal or obvious gastrointestinal disease; type 3 BAD is associated with gastrointestinal disorders, such as small intestinal bacterial overgrowth, celiac disease, or chronic pancreatitis; a fourth category of BAD may result from excessive hepatic bile acid synthesis caused by medications. This patient appears to have type 2 BAD; therefore, Answer B is correct. BAD has been shown to account for about one-third of patients with chronic diarrhea or irritable bowel syndrome with diarrhea.

References

1. Camilleri M. Bile acid diarrhea: prevalence, pathogenesis, and therapy. Gut Liver. 2015 May 23;9[3]:332-9.

2. Wedlake L., et al. Systematic review: The prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2009;30:707-17.

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