On 1/30/2025 at 1:06 PM, JPNola said:

BAM is not commonly diagnosed in the United States because the SHeCat test isn't FDA approved and is very expensive. There are only about 4 facilities in the USA that will administer the test. I had my gallbladder out years ago. No real problems. Some bouts that were diagnosed as IBS-D. But I had a partial Nissan Fundiplication in November 2023 and I've never been the same. Full blown BAM. Lost 35 pounds in a year and I was not overweight to begin with. So what I have learned during this journey is that sequestrants can quit working. They can also cause diarrhea. Someone mentioned semiglutides. There are research articles that concur this can be effective. It is not an option for me because I'm already struggling with weight loss. There are a few other treatments out there that offer liver and pancreatic support. If you are in America, you will need to take charge of treatment. My GI and my GP both told me they'd never had anyone with this. I told them both that they had, but the diagnosis wasn't correctly made. I've been lucky that both my doctors have embraced this and are researching it. And just for context, I don't live in rural America. I'm in a major metropolitan area. 

I am in the SouthWest USA and I had a robotic assisted paraesophageal hiatal hernia repaired with Fundoplication. I had diarhrea from the day after the surgery was done. I have had IBS and many other stomach issues over 32 years and I previously had all symptoms under control and was able to eat normally, except for gluten and dairy free. I was also on semiglutide and feeling pretty good with no stomach issue symptoms. Now I am off semiglutide (for the surgery) and a mess. Ever since this surgery, I cannot stop the diarrhea each time I eat. I also have a lot of wind and a horrible smell with it. I believe I have BAM. I did not have a test, however, I was given cholestyramine packets by a GI doctor who I loved (she was amazing) and they helped so much. Now I have Colesevelam and I am trying that with these new issues and hoping this will help get me back to a fairly normal situation. I have already cancelled one trip. I am hoping I don't have to cancel another! This has been another nightmare upon a lifetime of nightmares! It does become exhausting. It's nice to have people to talk to about this though - this is not something you can talk to everyone about!

There was a new research study published which found that the probiotic Visbiome appeared to modify the microbiome which is distributed by BAM.

ABSTRACT

Background

Bile acid (BA) malabsorption (BAM) is a common cause of chronic diarrhoea and may occur in some patients due to abnormalities of the gut microbiota. Effects of probiotics on faecal secretory BAs, particularly the primary BA, chenodeoxycholic acid, are unclear.

Aim/Methods

We conducted a randomized, double-blind, placebo-controlled trial of the De Simone formulation 8-strain probiotic in 24 patients previously diagnosed with BAM. Patients were randomized to 3 weeks of the probiotic (900 billion bacteria) or placebo (maltose), both administered three times daily. Symptoms, serum 7αC4, faecal primary BAs, intestinal permeability by ¹³C-mannitol-lactulose test (0.1 and 1 g of the sugars respectively) over 24 h, faecal short chain fatty acids (SCFA), microbiome, and metabolome were assessed at baseline and post-intervention.

Results

Data from 22 patients were included. Probiotic supplementation was associated with a significant decrease in % faecal primary BAs (chenodeoxycholic acid and cholic acid) with median change from baseline −5.7 [IQR −10.3, 0.9]% compared to 9.8 [IQR 0.2, 20.6]% on placebo (p = 0.012). The faecal microbiome was significantly different in the probiotic group after intervention, driven by probiotic-specific species. There were no significant differences in symptoms, intestinal permeability, or SCFA. However, there was a numerical difference in the changes from baseline in 0-2 h ¹³C-mannitol excretion −1.9 [−13.9, 4.2] mg for the probiotic and 1.0 (−0.5, 12.7) mg for placebo (p = 0.084).

Conclusions

The De Simone formulation probiotic induced significant microbiome and metabolome changes in patients with BAM, ultimately leading to a decrease in % faecal primary BAs and possible reduction in intestinal permeability. Clinical Trials.gov registration NCT #06609148, January 2, 2025.

https://onlinelibrary.wiley.com/doi/10.1111/apt.70876