Managing Bile Salt Malabsorption
Bile is a fluid produced in the liver and stored in the gallbladder. It is released into the duodenum during a meal to help digest fats and is reabsorbed in the ileum. When part of the ileum is lost, it results in malabsorption of bile acids which can lead to diarrhea.
This may be treated by medications that bind bile, such as cholestyramine (Questran, Cholybar). However, when too much ileum is removed (greater than 100 cm/3.3 feet of the terminal ileum), more severe bile salt malabsorption may occur, and the liver is unable to compensate. When that happens cholestyramine may actually worsen steatorrhea, or undigested fat in the stools.