Treatment of Functional Diarrhea in Proven Bile Acid Diarrhoea

Clinical Scenario

This protocol addresses patients presenting with functional diarrhea (DD91.2) in whom bile acid diarrhoea has been confirmed. The confirmed diagnosis of bile acid diarrhoea defines both patient selection and the therapeutic direction.

UEG/ESNM guidelines recommend bile acid sequestrants for patients with proven bile acid diarrhoea.

Treatment Approach

Management centres on a specific class of agents targeting bile acid excess. Within this class, the choice of agent is guided by individual patient tolerability — not every agent in the class is equally well-accepted, and tolerability considerations shape which option is used.

The full sequencing — which agent to start, when to switch, and what alternatives apply — is detailed in the complete structured regimen.

Complete regimen available via the link below.

Treatment Goals

Clinical success in this setting is measured by:

Decrease in total stool frequency Reduction in watery stools

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1002/ueg2.12259

UEG/ESNM recommend FOR the use of bile acid sequestrants in patients with proven bile acid diarrhoea.

Bile acid sequestrants include colestyramine, colestipol, and colesevelam.

Colestyramine has remained the usual first choice drug but is often poorly tolerated, sometimes because the drug is not introduced slowly, or because of its formulation.

Colesevelam may be more acceptable in those who fail colestyramine.

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