What are the indications for referring a patient with suspected bile acid malabsorption to a specialist?

Indications for referring a patient with suspected bile acid malabsorption to a specialist include:

• If the diagnosis remains uncertain after primary care assessment, especially when infection and other common causes of acute diarrhoea have been excluded and a chronic cause such as bile acid diarrhoea is suspected.
• If the patient has chronic diarrhoea with no clear diagnosis and symptoms suggest bile acid diarrhoea.
• If there are red flag symptoms or features suggestive of other serious conditions that require specialist evaluation.
• If the patient is under 40 years old and does not have typical symptoms of a functional bowel disorder but has severe symptoms and documented diarrhoea.
• When further assessment and management are needed beyond primary care, including specialized investigations or treatment.

These referral indications are based on guidelines for the investigation of chronic diarrhoea in adults and expert consensus, which recommend referral for bile acid diarrhoea when diagnosis is uncertain or symptoms are severe and persistent despite initial assessment in primary care NICE CKS.