Ileal resection accelerates bile acid malabsorption symptoms
Clinical cases: Gastroenterology
Situation
An 80-year-old female known to have Crohn’s disease since 1990, resulting in multiple ileal resections (one in 2009 and two in 1990), presented to the gastrointestinal clinic for evaluation of severe watery diarrhea, urge incontinence, weight loss, decreased appetite, and fatigue. Symptoms had been ongoing for several years but have become severe over the past year. At the time of the encounter, she was one year status post ileal resection revision, where 18 inches of the small bowel had been removed. Recent endoscopic evaluation showed significant improvement of her Crohn’s disease.
Recommended testing
BAMRP | Bile Acids Malabsorption Panel, Serum and Feces
CDPCR | Clostridioides difficile Toxin, PCR, Feces
EIACD | Clostridioides difficile Toxin, EIA, Feces
Stool collection for assessment of bile acid measurements, stool collection to assess for Clostridium difficile (C. difficile), fecal calprotectin testing, and local breath testing to rule out small intestinal bacterial overgrowth.
Results
- The patient's hydrogen breath test was negative for small intestinal bacterial overgrowth, and the C. difficile test was also negative. Her calprotectin levels were borderline (58.3 mcg/g). Her bile acid malabsorption results showed as elevated: 7AC4 bile acid synthesis (285 ng/mL) and %CDCA + CA (97.6%). Based on these results, she was diagnosed with bile acid malabsorption due to her ileal resection.
Next steps
- It was recommended to the patient to consider starting cholestyramine at a dose of one pack per day or twice daily, and to adjust based on clinical response. Additionally, it was recommended she continue using Imodium as needed to reduce intestinal motility, given the absence of an ileocecal valve.
Learn more about our testing for bile acid malabsorption.
