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The Role of Bile Acid Sequestrant in Diarrhea Management: Too Good to Be True?

Helen Senderovich and Ehsan Ghassem Khani

Background: Chronic diarrhea can be caused by a wide range of conditions including malabsorption (e.g. Bile acid malabsorption (BAM)), infection (eg. Clostridium difficile (C. difficile)), other gastrointestinal diseases (e.g. ileal resection, bile acid overproduction, pancreatic insufficiency, bacterial overgrowth, cholecystectomy and malignancy), and even stress and anxiety. BAM is a condition associated with inability to effectively absorb bile in the small intestine which results in chronic diarrhea. Cholestyramine is a bile acid sequestrant (BAS) with the potential to control chronic diarrhea induced by BAM and C. difficile infection.
Objective: To explore the role of BAS in the management of chronic diarrhea and assess how the theoretical knowledge is supported by practical evidence.
Methods: Ovid (MEDLINE, PsychInfo, Embase) was searched for "Cholestyramine Resin” AND "Chronic Diarrhea" with limits on the years 1946 – present. 8 studies which were deemed to be relevant to the objective at hand were summarized. Additional sources from Grey literature search were added using the same research strategies.
Results: The results showed positive therapeutic impact of BAS, particularly cholestyramine in reducing stool frequency regardless of type and severity of BAM-induced diarrhea. However, low tolerability of BAS due to adverse effects can limit its use in some patients.
Conclusion: BAS was more likely to be a good option as a short-term medication to better control symptoms and prevent illness. Therapeutic effect of BAS in the management of chronic diarrhea can be considered in palliative care to benefit patients who can tolerate this medication although not without the existent controversies.