Die chologene Diarrhö ist eine der häufigsten nicht
diagnostizierten Ursachen der chronischen Diarrhö, der zahlreiche
verschiedene Pathophysiologien zugrunde liegen können. Auch nach
Ausschlussdiagnostik der häufigeren Ursachen verbleiben bis zu
5% der Bevölkerung von einer ungeklärten chronischen
Diarrhö betroffen. In diesem Kollektiv findet sich in bis zu 50%
als Ursache eine chologene Diarrhö.
Abstract
The various pathophysiologies leading to bile acid diarrhea are well
characterized. In this way, bile acid diarrhea can be divided into primary,
secondary and tertiary subtypes. Common to all causes is the increased amount of
bile acids in the colon and in the faeces and the resulting secretory-osmotic
diarrhea, in more severe forms in combination with steatorrhea. The diagnosis of
bile acid diarrhea follows a clear algorithm which, in addition to the search
for the cause and possibly a therapeutic trial, recognizes the
75SeHCAT test as the reference method for the detection of an
increased loss of bile acids. In view of the chronic nature of the symptoms and
the need for permanent, lifelong therapy, the use of a one-time, reliable
diagnostic test is justified, though the test is currently only available at a
few centers. In addition to the treatment of identifiable underlying diseases,
the current treatment includes the use of drugs that bind bile acids, with
additional nutritional recommendations and vitamin substitutions.
The present review article summarizes the pathophysiology and importance of bile
acid diarrhea and discusses the current approach towards diagnosis and
treatment.
Schlüsselwörter
chologene Diarrhö - Diarrhö - Gallensäurenverlust - SeHCAT-Test
Key words
bile acid diarrhea - diarrhea - bile acid loss - SeHCAT test
