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62-408: SeHCAT ( 23-seleno-25-homotaurocholic acid , selenium homocholic acid taurine , or tauroselcholic acid ) is a drug used in a clinical test to diagnose bile acid malabsorption . SeHCAT is a taurine-conjugated bile acid analog which was synthesized for use as a radiopharmaceutical to investigate in vivo the enterohepatic circulation of bile salts . By incorporating the gamma-emitter Se into

124-507: A GLP-1 receptor agonist had unexpected effects in clinical cases with co-existing bile acid diarrhoea which led to a randomised, double-blind, active-comparator, non-inferiority clinical trial. This trial demonstrated superiority in favour of liraglutide compared with colesevelam in reducing stool frequency and improved pathophysiological markers, suggesting it may be a new, safe and more effective treatment compared with current established, cheaper treatment modalities. Bile acid malabsorption

186-401: A classification into three types was proposed: Bile acid sequestrants are the main agents used to treat bile acid malabsorption. Cholestyramine and colestipol , both in powder form, have been used for many years. Unfortunately, many patients find them difficult to tolerate; although the diarrhea may improve, other symptoms such as abdominal pain and bloating may worsen. Colesevelam is

248-466: A day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination , loss of skin color , a fast heart rate , and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed , however, are normal. The most common cause

310-657: A defense mechanism". The following types of diarrhea may indicate further investigation is needed: A severity score is used to aid diagnosis in children. When diarrhea lasts for more than four weeks a number of further tests may be recommended including: A 2019 guideline recommended that testing for ova and parasites was only needed in people who are at high risk though they recommend routine testing for giardia . Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were not recommended. Worldwide in 2004, approximately 2.5 billion cases of diarrhea occurred, which resulted in 1.5 million deaths among children under

372-470: A few cases such as those who have bloody diarrhea and a high fever, those with severe diarrhea following travelling , and those who grow specific bacteria or parasites in their stool. Loperamide may help decrease the number of bowel movements but is not recommended in those with severe disease. About 1.7 to 5 billion cases of diarrhea occur per year. It is most common in developing countries , where young children get diarrhea on average three times

434-689: A frequent cause. In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by Clostridioides difficile often causes severe diarrhea. Parasites, particularly protozoa e.g., Cryptosporidium spp., Giardia spp., Entamoeba histolytica , Blastocystis spp., Cyclospora cayetanensis , are frequently the cause of diarrhea that involves chronic infection. The broad-spectrum antiparasitic agent nitazoxanide has shown efficacy against many diarrhea-causing parasites. Other infectious agents, such as parasites or bacterial toxins, may exacerbate symptoms. In sanitary living conditions where there

496-413: A high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea. In most of these cases, osmotic diarrhea stops when the offending agent (e.g., milk or sorbitol) is stopped. Exudative diarrhea occurs with the presence of blood and pus in

558-435: A liquid, or "loose", bowel movement. Acute diarrhea is most commonly due to viral gastroenteritis with rotavirus , which accounts for 40% of cases in children under five. In travelers , however, bacterial infections predominate. Various toxins such as mushroom poisoning and drugs can also cause acute diarrhea. Chronic diarrhea can be the part of the presentations of a number of chronic medical conditions affecting

620-464: A population, especially in the absence of water filtration or purification. Human feces contains a variety of potentially harmful human pathogens . Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system. Zinc deficiency , a condition often found in children in developing countries can, even in mild cases, have

682-437: A response to bile acid sequestrants , in the absence of other disorders of the intestine, is characteristic of idiopathic bile acid malabsorption – also called primary bile acid diarrhea . These patients are frequently misdiagnosed as having the irritable bowel syndrome , as clinicians fail to recognize the condition, do not think of performing a SeHCAT test, or do not have it available. There have been at least 18 studies of

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744-414: A result, if it is stopped, there might be a delay in recovery. They cite in support of this argument research published in 1973 that found that treating Shigella with the anti-diarrhea drug (Co-phenotrope, Lomotil ) caused people to stay feverish twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent

806-630: A review of 18 studies of the use of SeHCAT testing in diarrhea-predominant irritable bowel syndrome patients, 32% of 1223 people had a SeHCAT 7-day retention of less than 10%, and 80% of these reported a response to cholestyramine, a bile acid sequestrant. A study from 2023 investigating the epidemiology of bile acid diarrhea in Denmark, found that people suffering from bile acid diarrhea seemed to have more co-morbidities, lower levels of income and education and more health care contacts compared with matches not suffering from bile acid diarrhea. Estimates of

868-435: A series of tests of intelligence. Diarrhea can cause electrolyte imbalances , kidney impairment , dehydration , and defective immune system responses. When oral drugs are administered, the efficiency of the drug is to produce a therapeutic effect and the lack of this effect may be due to the medication travelling too quickly through the digestive system, limiting the time that it can be absorbed. Clinicians try to treat

930-438: A significant impact on the development and proper functioning of the human immune system. Indeed, this relationship between zinc deficiency and reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever. Similarly, vitamin A deficiency can cause an increase in

992-404: A tablet which is well tolerated and has been shown in placebo-controlled, randomized clinical trials to be effective. The farnesoid X receptor agonist obeticholic acid has shown clinical and biochemical benefits in a proof of concept study. Tropifexor is another farnesoid X receptor agonist that has been studied, showing improvements in biochemistry and colonic transit. Liraglutide ,

1054-806: A week over the previous three months. Symptoms of diarrhea-predominant IBS can be managed through a combination of dietary changes, soluble fiber supplements and medications such as loperamide or codeine . About 30% of patients with diarrhea-predominant IBS have bile acid malabsorption diagnosed with an abnormal SeHCAT test. Diarrhea can be caused by other diseases and conditions, namely: Over 700 medications, such as penicillin , are known to cause diarrhea. The classes of medications that are known to cause diarrhea are laxatives, antacids, heartburn medications, antibiotics, anti-neoplastic drugs, anti-inflammatories as well as many dietary supplements. According to two researchers, Nesse and Williams , diarrhea may function as an evolved expulsion defense mechanism. As

1116-484: A year. Total deaths from diarrhea are estimated at 1.53 million in 2019—down from 2.9 million in 1990. In 2012, it was the second most common cause of deaths in children younger than five (0.76 million or 11%). Frequent episodes of diarrhea are also a common cause of malnutrition and the most common cause in those younger than five years of age. Other long term problems that can result include stunted growth and poor intellectual development. The word diarrhea

1178-430: Is isotonic with plasma even during fasting. It continues even when there is no oral food intake. Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea. Osmotic diarrhea can also result from maldigestion (e.g., pancreatic disease or coeliac disease ) in which

1240-646: Is a symptom of, among others, Shigella , Entamoeba histolytica , and Salmonella . Diarrheal disease may have a negative impact on both physical fitness and mental development. "Early childhood malnutrition resulting from any cause reduces physical fitness and work productivity in adults", and diarrhea is a primary cause of childhood malnutrition. Further, evidence suggests that diarrheal disease has significant impacts on mental development and health; it has been shown that, even when controlling for helminth infection and early breastfeeding, children who had experienced severe diarrhea had significantly lower scores on

1302-479: Is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or malnourished individuals, diarrhea can lead to severe dehydration and can become life-threatening. Open defecation is a leading cause of infectious diarrhea leading to death. Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from

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1364-442: Is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions , especially chloride ions (Cl ). Therefore, to maintain a charge balance in the gastrointestinal tract , sodium (Na ) is carried with it, along with water. In this type of diarrhea intestinal fluid secretion

1426-535: Is an infection of the intestines due to a virus , bacterium , or parasite —a condition also known as gastroenteritis . These infections are often acquired from food or water that has been contaminated by feces , or directly from another person who is infected. The three types of diarrhea are: short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea (lasting more than two weeks, which can be either watery or bloody). The short duration watery diarrhea may be due to cholera , although this

1488-584: Is best known in humans, it affects many other species, notably among primates . The cecal appendix , when present, appears to afford some protection against diarrhea to young primates. Numerous studies have shown that improvements in drinking water and sanitation ( WASH ) lead to decreased risks of diarrhoea. Such improvements might include for example use of water filters, provision of high-quality piped water and sewer connections. In institutions, communities, and households, interventions that promote hand washing with soap lead to significant reductions in

1550-457: Is common in Crohn's disease but not always recognized. Most people with previous ileal resection and chronic diarrhea will have abnormal SeHCAT tests and can benefit from bile acid sequestrants. People with primary bile acid diarrhea are frequently misdiagnosed as having irritable bowel syndrome . When SeHCAT testing is performed, the diagnosis of primary bile acid diarrhea is commonly made. In

1612-585: Is considered to be normal, with values less than 15% signifying excessive bile acid loss, as found in bile acid malabsorption . With more frequent measurements, it is possible to calculate SeHCAT retention whole-body half-life; this is not routinely measured in a clinical setting. A half-life of greater than 2.8 days has been quoted as normal. The SeHCAT test is used to investigate patients with suspected bile acid malabsorption , who usually experience chronic diarrhea , often passing watery feces 5 to 10 times each day. When ileum has been removed following surgery, or

1674-539: Is defined by the World Health Organization as having three or more loose or liquid stools per day, or as having more stools than is normal for that person. Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days, by World Gastroenterology Organization . Acute diarrhea that is watery may be known as AWD (Acute Watery Diarrhoea.) Secretory diarrhea means that there

1736-674: Is from the Ancient Greek διάρροια from διά dia "through" and ῥέω rheo "flow". Diarrhea is the spelling in American English , whereas diarrhoea is the spelling in British English . Slang terms for the condition include "the runs", "the squirts" (or "squits" in Britain ) and "the trots". The word is often pronounced as / ˌ d aɪ ə ˈ r iː ə / DY -ə- REE -ə . Diarrhea

1798-723: Is inflamed in Crohn's disease , the 7-day SeHCAT retention usually is abnormal, and most of these patients will benefit from treatment with bile acid sequestrants . The enterohepatic circulation of bile acids is reduced in these patients with ileal abnormalities and, as the normal bile acid retention exceeds 95%, only a small degree of change is needed. Bile acid malabsorption can also be secondary to cholecystectomy , vagotomy and other disorders affecting intestinal motility or digestion such as radiation enteritis, celiac disease , and small intestinal bacterial overgrowth . A similar picture of chronic diarrhea , an abnormal SeHCAT retention and

1860-555: Is not licensed in the USA, and is underutilized even where it is available. Older methods such as the C-glycocholic breath test are no longer in routine clinical use. Measurement of 7α-Hydroxy-4-cholesten-3-one , (C4), a bile acid precursor, in serum, shows the increased bile acid synthesis found in bile acid malabsorption. This test is an alternative diagnostic means when available. Fasting blood FGF19 values may have value in

1922-420: Is not more common in most patients and does not affect function. Primary bile acid diarrhea (Type 2 bile acid "malabsorption") may be caused by an overproduction of bile acids. Several groups of workers have failed to show any defect in ileal bile acid absorption in these patients, and they have an enlarged bile acid pool, rather than the reduced pool expected with malabsorption. The synthesis of bile acids in

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1984-437: Is rare in the developed world. If blood is present, it is also known as dysentery . A number of non-infectious causes can result in diarrhea. These include lactose intolerance , irritable bowel syndrome , non-celiac gluten sensitivity , celiac disease , inflammatory bowel disease such as ulcerative colitis , hyperthyroidism , bile acid diarrhea , and a number of medications. In most cases, stool cultures to confirm

2046-591: Is reabsorbed efficiently in the ileum, with kinetics similar to natural bile acids. It was soon shown to be the most convenient and accurate method available to assess and measure bile acid turnover in the intestine. SeHCAT testing was commercially developed by Amersham International Ltd ( Amersham plc is now part of GE Healthcare Medical Diagnostics division) for clinical use to investigate malabsorption in patients with diarrhea . This test has replaced C-labeled glycocholic acid (or taurocholic acid) breath tests and fecal bile acid measurements, which now have no place in

2108-504: Is reduced, the intestine is less efficient at bile acid reabsorption (Type 1 bile acid malabsorption). If intestinal motility is affected by gastro-intestinal surgery, or bile acids are deconjugated by small intestinal bacterial overgrowth , absorption is less efficient (Type 3 bile acid malabsorption). A very small proportion of the patients with no obvious disease (Type 2 bile acid malabsorption) may have mutations in ASBT, but this mutation

2170-421: Is scanned supine or prone with anterior and posterior acquisition from head to thigh 1 to 3 hours after taking the capsule. Scanning is repeated after 7 days. Background values are subtracted and care must be taken to avoid external sources of radiation in a nuclear medicine department. From these measurements, the percent retention of SeHCAT at 7 days is calculated. A 7-day SeHCAT retention value greater than 15%

2232-494: Is significant variation in clinical practice in this regard. The effective dose of radiation for an adult given 370 kBq of SeHCAT is 0.26 mSv. (For comparison, the radiation exposure from an abdominal CT scan is quoted at 5.3 mSv and annual background exposure in the UK 1-3 mSv.) Measurements were originally performed with a whole-body counter but are usually performed now with an uncollimated gamma camera. The patient

2294-455: Is the first step in absorption at the brush-border membrane. The cytoplasmic ileal bile acid binding protein (IBABP, ILBP, gene symbol FABP6 ) and the basolateral heterodimer of OSTα and OSTβ transfer bile acids through and out of the cell where they eventually enter the portal vein . These bile acid transporters are all highly expressed in the ileum but not in the liver, jejunum or colon. When expression of these specialized transporters

2356-536: Is the most common cause in children under five years old. Adenovirus types 40 and 41, and astroviruses cause a significant number of infections. Shiga-toxin producing Escherichia coli , such as E coli o157:h7 , are the most common cause of infectious bloody diarrhea in the United States. Campylobacter spp. are a common cause of bacterial diarrhea, but infections by Salmonella spp., Shigella spp. and some strains of Escherichia coli are also

2418-652: The Bristol stool scale ), sometimes with steatorrhea , increased frequency and urgency of defecation are common manifestations, often with fecal incontinence and other gastrointestinal symptoms such as abdominal swelling, bloating and abdominal pain . People with this disorder often report impairments of mental health and well-being , including fatigue , dizziness , anxiety about leaving home (primarily due to fear of fecal incontinence), depression , one survey reports. It contributes in delays in diagnosis. Bile acids (also called bile salts ) are produced in

2480-412: The large intestine per 24 h. When larger amounts of bile acids enter the large intestine , they stimulate water secretion and intestinal motility in the colon , which causes symptoms of chronic diarrhea . The ileum is very efficient at absorbing the glyco- and taurine -conjugated forms of the bile salts. The apical sodium-dependent bile salt transporter (ASBT, IBAT, gene symbol SLC10A2 )

2542-494: The liver , secreted into the biliary system , stored in the gallbladder and are released after meals stimulated by cholecystokinin . They are important for the digestion and absorption of fats (lipids) in the small intestine . Usually over 95% of the bile acids are absorbed in the terminal ileum and are taken up by the liver and resecreted. This enterohepatic circulation of bile acids takes place four–six times in 24 hours and usually less than 0.5 g of bile acids enter

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2604-515: The SeHCAT molecule, the retention in the body or the loss of this compound into the feces could be studied easily using a standard gamma camera, available in most clinical nuclear medicine departments. SeHCAT has been shown to be absorbed from the gut and excreted into the bile at the same rate as cholic acid , one of the major natural bile acids in humans. It undergoes secretion into the biliary tree, gallbladder and intestine in response to food, and

2666-610: The age of five. Greater than half of these were in Africa and South Asia. This is down from a death rate of 4.5 million in 1980 for gastroenteritis. Diarrhea remains the second leading cause of infant mortality (16%) after pneumonia (17%) in this age group. The majority of such cases occur in the developing world, with over half of the recorded cases of childhood diarrhea occurring in Africa and Asia , with 696 million and 1.2 billion cases, respectively, compared to only 480 million in

2728-419: The bloodstream via the intestinal tract in the small intestine. Prior to defecation, the large intestine reabsorbs the water and other digestive solvents in the waste product in order to maintain proper hydration and overall equilibrium. Diarrhea occurs when the large intestine is prevented, for any number of reasons, from sufficiently absorbing the water or other digestive fluids from fecal matter, resulting in

2790-455: The conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of fecal waste ( sanitation ), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase

2852-637: The diarrheas by reducing the dosage of medication, changing the dosing schedule, discontinuation of the drug, and rehydration. The interventions to control the diarrhea are not often effective. Diarrhea can have a profound effect on the quality of life because fecal incontinence is one of the leading factors for placing older adults in long term care facilities (nursing homes). In the latter stages of human digestion, ingested materials are inundated with water and digestive fluids such as gastric acid , bile , and digestive enzymes in order to break them down into their nutrient components, which are then absorbed into

2914-620: The disorder but there are difficulties with all of them. Diagnosis of bile acid malabsorption is easily and reliably made by the SeHCAT test. This nuclear medicine test involves two scans a week apart and so measures multiple cycles of bile acid excretion and reabsorption. There is limited radiation exposure (0.3 mSv). Retention of SeHCAT at 7 days is normally above 15%; values less than 15%, 10% and 5% predict respectively mild, moderate and severe abnormal retention and an increasing likelihood of response to bile acid sequestrants . This test

2976-469: The exact cause are not required. Diarrhea can be prevented by improved sanitation , clean drinking water , and hand washing with soap. Breastfeeding for at least six months and vaccination against rotavirus is also recommended. Oral rehydration solution (ORS)—clean water with modest amounts of salts and sugar —is the treatment of choice. Zinc tablets are also recommended. These treatments have been estimated to have saved 50 million children in

3038-504: The frequency of diarrhea   ... Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care." One of the most common causes of infectious diarrhea is a lack of clean water. Often, improper fecal disposal leads to contamination of groundwater. This can lead to widespread infection among

3100-429: The intestine. Common causes include ulcerative colitis , Crohn's disease , microscopic colitis , celiac disease , irritable bowel syndrome , and bile acid malabsorption . There are many causes of infectious diarrhea, which include viruses , bacteria and parasites. Infectious diarrhea is frequently referred to as gastroenteritis . Norovirus is the most common cause of viral diarrhea in adults, but rotavirus

3162-670: The liver is negatively regulated by the ileal hormone fibroblast growth factor 19 ( FGF19 ), and lower levels of this hormone result in overproduction of bile acids, which are more than the ileum can absorb. A study found that patients suffering from bile acid diarrhea are characterized by a dysmetabolic and prediabetic-like profile, with higher postprandial concentrations of glucose, insulin and glucagon, compared with matched healthy controls. The underlying mechanisms are not fully understood. Furthermore, gut microbiome composition differs from that of people who do not suffer from bile acid diarrhea. Several methods have been developed to identify

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3224-575: The nutrients are left in the lumen to pull in water. Or it can be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels). In healthy individuals, too much magnesium , vitamin C or undigested lactose can produce osmotic diarrhea and distention of the bowel. A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have fructose malabsorption , excess fructose intake can also cause diarrhea. High-fructose foods that also have

3286-417: The other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis. If there is blood visible in the stools, it is also known as dysentery . The blood is a trace of an invasion of bowel tissue. Dysentery

3348-403: The past 25 years. When people have diarrhea it is recommended that they continue to eat healthy food, and babies continue to be breastfed. If commercial ORS is not available, homemade solutions may be used. In those with severe dehydration, intravenous fluids may be required. Most cases, however, can be managed well with fluids by mouth. Antibiotics , while rarely used, may be recommended in

3410-467: The population prevalence suggest that 1% of the adult population could have primary bile acid diarrhea (Type 2 bile acid malabsorption). A nationwide cohort study indicates an association between bile acid diarrhea and gastrointestinal cancers . Chronic diarrhea Diarrhea ( American English ), also spelled diarrhoea or diarrhœa ( British English ), is the condition of having at least three loose, liquid, or watery bowel movements in

3472-512: The potential for increased risk of disease contraction. Malabsorption is the inability to absorb food fully, mostly from disorders in the small bowel, but also due to maldigestion from diseases of the pancreas . Causes include: The two overlapping types here are of unknown origin: Another possible cause of diarrhea is irritable bowel syndrome (IBS), which usually presents with abdominal discomfort relieved by defecation and unusual stool (diarrhea or constipation ) for at least three days

3534-520: The recognition of the disease and prediction of response. The various biomarkers give similar diagnostic yields of around 25% in patients with functional bowel disorders with diarrhea. In countries such as the US, where SeHCAT is not available, fecal bile acids and C4 are available to make the diagnosis. Bile acid malabsorption was first recognized in patients with ileal disease . When other causes were recognized, and an idiopathic, primary form described,

3596-751: The rest of the world. Infectious diarrhea resulted in about 0.7 million deaths in children under five years old in 2011 and 250 million lost school days. In the Americas, diarrheal disease accounts for a total of 10% of deaths among children aged 1–59 months while in South East Asia, it accounts for 31.3% of deaths. It is estimated that around 21% of child mortalities in developing countries are due to diarrheal disease. The World Health Organization has reported that "deaths due to diarrhoeal diseases have dropped by 45%, from sixth leading cause of death in 2000 to thirteenth in 2021." Even though diarrhea

3658-451: The routine clinical investigation of malabsorption . A capsule containing radiolabelled SeHCAT (with 370 kBq of Selenium-75 and less than 0.1 mg SeHCAT) is taken orally with water, to ensure passage of the capsule into the gastrointestinal tract. The physical half life of Se is approximately 118 days; activity is adjusted to a standard reference date. Patients may be given instructions to fast prior to capsule administration; there

3720-432: The severity of diarrheal episodes. However, there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status, others suggest an increase in the rate associated with deficiency. Given that estimates suggest 127 million preschool children worldwide are vitamin A deficient, this population has

3782-415: The stool. This occurs with inflammatory bowel diseases , such as Crohn's disease or ulcerative colitis , and other severe infections such as E. coli or other forms of food poisoning. Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of

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3844-407: The use of SeHCAT testing in diarrhea-predominant irritable bowel syndrome patients. When these data were combined, 32% of 1223 patients had a SeHCAT 7-day retention of less than 10%, and 80% of these reported a response to cholestyramine, a bile acid sequestrant . Bile acid malabsorption A persistent (chronic) history of diarrhea , with watery or mushy, unformed stools, (types 6 and 7 on

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