BAM – IBS Researcher

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Table of Contents
What Is BAM?
Causes Of BAM
How Common Is BAM?
BAM Diagnosis
BAM Treatment
When To Consider BAM
Further Reading And References

What Is BAM?

BAM (bile acid malabsorption) is a condition that can be mistaken for IBS since it can have similar symptoms to IBS-D. (1)

The gall bladder releases bile into the small intestine to break down fats. Most of the bile is reabsorbed and recycled from the small intestine, with a small amount reaching the large intestine (colon) where it is eliminated with stools. If someone has an issue with reabsorbing bile, more ends up in the colon than normal. In these cases, the colon releases extra water speeding up the transit of waste causing watery diarrhoea. (2)

Causes Of BAM

There are various conditions or circumstances that can cause BAM:

Diseases affecting the gut, particularly the last part of the small bowel (terminal ileum), which leads to the large bowel (colon)
Removal of the terminal ileum
Chron’s disease
Gallbladder removal (cholecystectomy)
Coeliac disease
Diseases affecting the pancreas
After radiotherapy
Some medications, including metformin, which is used to treat type 2 diabetes
Unknown cause called idiopathic bile acid diarrhoea

(1)

How Common Is BAM?

1 in every 100 people are affected by BAM
1 in 3 people diagnosed with IBS
Idiopathic bile acid diarrhoea is most common in adults between 30 and 70 years old

(1)

BAM Diagnosis

The specific tests for diagnosing BAM are:

A test called selenium homocholic acid taurine (SeHCAT), measuring the amount of bile acids in your stool; or
A blood test for 7a-hydroxy-4-cholesten-3-one (C4). Increased levels indicate bile acid diarrhoea

(1)

BAM Treatment

Low fat diet
Bile acid binding medication: colestyramine (most common), colestipol or colesevelam

(1)

When To Consider BAM

Discuss the possibility of BAM with your GP if:

You have one of the causes of BAM, or
You have been diagnosed with diarrhoea dominant IBS (IBS-D) and all the usual IBS remedies such as probiotics, gut directed hypnotherapy and FODMAP elimination and reintroduction diet (followed strictly, ideally with the help of a FODMAP trained dietitian) are not helping