Testing finds bile acid-induced diarrhea caused by cholecystectomy
Clinical cases: Gastroenterology
Situation
A 66-year-old female presented to the gastrointestinal clinic with chronic diarrhea for the past two years. She was two years status post cholecystectomy, which occurred in February 2022. She reported that her diarrhea had started shortly after her cholecystectomy. The diarrhea got worse after a C. difficile infection for which she was treated with vancomycin, then fidaxomicin, and finally a fecal microbiologic transplant in September 2022. The C. difficile infection resolved at that time with a documented negative PCR test result and improvement in the diarrhea. However, the diarrhea did not resolve. She reported passing four to six bowel movements a day. She was previously investigated with a colonoscopy and EGD in 2022, with gastric and duodenal biopsies that were reassuring. She was also on sertraline and lorazepam for her mood disorder.
Recommended testing
BAMRP | Bile Acids Malabsorption Panel, Serum and Feces
CDPCR | Clostridioides difficile Toxin, PCR, Feces
EIACD | Clostridioides difficile Toxin, EIA, Feces
Stool for C. difficile, fecal calprotectin testing, and bile acid malabsorption panel testing, as well as sigmoidoscopy with random colonic biopsies for evaluation of microscopic colitis.
Results
- The patient's C. difficile and calprotectin results were negative. Sigmoidoscopy done with random colonic biopsies was reassuring. Her stool studies showed elevated bile acid, suggesting bile acid-induced diarrhea (7AC4: 24.7ng/mL, % CDCA + CA 75.9%). Based on these results, she was diagnosed with bile acid malabsorption due to her cholecystectomy.
Next steps
- It was recommended she take one Welchol tablet in the morning before breakfast and two tablets in the evening at bedtime.
Learn more about our testing for bile acid malabsorption.
