Bile acid diarrhea is a disease characterized by a chronic, nonbloody, watery diarrhea. Inadequate small bowel reabsorption of bile acids results in a secretory diarrhea that is triggered when these bile acids reach the colon. This diarrhea may be accompanied by urgency and fecal incontinence. This condition can result from bile acid overproduction or impaired small bowel absorption, as can occur in Crohn ileitis, celiac disease, or in patients with a prior cholecystectomy.

Bile acid diarrhea is a chronic condition with no known cure, necessitating lifelong therapy, barring treatment of an underlying cause (eg, Crohn ileitis). The diagnosis is often underdiagnosed and is thought to be quite common with a prevalence of 4%-5% of the population.

Patients with a history of the following are at risk for bile acid diarrhea:

• Crohn ileitis
• Terminal ileum resection
• Abdominal radiation
• Prior cholecystectomy
• Celiac disease

Due to limitations of testing specificity and sensitivity, bile acid diarrhea is often a clinical diagnosis based on patient symptoms and risk factors.