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Bile Acid Malabsorption — RACP Adult Medicine MCQ

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HardGastroenterologyBile Acid MalabsorptionRACP Adult Medicine

A patient has chronic watery diarrhoea after cholecystectomy, normal faecal elastase and negative coeliac serology. SeHCAT retention is below 5%. Which treatment is most appropriate?

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Correct answer: AStart a bile-acid sequestrant and titrate it around symptoms, interactions and tolerability

The best answer is “Start a bile-acid sequestrant and titrate it around symptoms, interactions and tolerability”. Very low SeHCAT retention supports bile-acid diarrhoea, and a bile-acid sequestrant such as colestyramine or colesevelam targets the mechanism. Dosing must account for constipation and binding of other medicines. Pancreatic insufficiency and coeliac disease are not supported; symptomatic antidiarrhoeal therapy may be adjunctive but does not address the demonstrated cause.

Reference: Gastroenterological Society of Australia: Clinical practice resources: https://gesa.org.au/Web/Resources/Clinical_Practice_Resources.aspx