#15 Understanding bile acid diarrhoea / malabsorption in IBD with Professor Julian Walters

Send us Fan MailIn Episode 15 of Wrestling the Octopus: the IBD Patient Podcast, Nigel and I cover a topic that receives not nearly as much attention as it should: Bile Acid Diarrhoea (BAD) / Bile Acid Malabsorption (BAM) in Crohn's disease. Our expert guest is gastroenterologist, Professor Julian Walters from Imperial College London in the UK.Through Nigel's story, we also get a candid view of what BAM feels like for inflammatory bowel disease patients who have had their terminal ileum removed. What You'll Learn In this EpisodeWhat is BAD/BAM? How bile acids normally work versus what happens when they’re not reabsorbed properly, especially in IBD patients with ileal disease or resection.Updated terminology: Why “bile acid diarrhoea” is now preferred over “bile acid malabsorption,” and what that means for diagnosis and treatment.Common causes of BAD: Crohn’s disease, gallbladder removal and genetic variants that lead to excess bile acid production.How to get diagnosed: A breakdown of the SeHCAT scan, C4 blood test and why access to testing varies across the UK.Treatment options that work: From bile acid sequestrants (like colesevelam and cholestyramine) to loperamide - can combining them help?Getting the timing right: Why taking sequestrants at night on an empty stomach may be more effective than following cholesterol-lowering instructions.Diet and lifestyle tips: How fatty meals can trigger symptoms and what you can do to reduce flare-ups.Emerging treatments: A glimpse into GLP-1 receptor agonists like liraglutide and semaglutide, and their potential role in managing BAD.Key PointsBAD affects more people than Crohn’s disease or ulcerative colitis - yet it remains underdiagnosed.SeHCAT is the gold standard test, but blood tests like C4 may offer cheaper alternatives soon.Don’t rely on loperamide (Imodium) without a formal diagnosis of BAD / BAM.If your symptoms fluctuate, track your diet as fatty meals may be the culprit.Nighttime dosing of sequestrants might be a game-changer for symptom control.Follow Professor Julian Walters on FacebookFollow Rachel at @bottomlineibdFollow Nigel at @crohnoid