Bile acid diarrhea is a common cause of diarrhea in patients with IBS and IBD. Currently, our diagnostic tools are unaccessible and often, therapeutic trials with bile acid sequestrants are used in the diagnosis. Dr Robert Battat shares his research with a new diagnostic marker, C4, in the diagnosis and management of B.A.D., leading to more targeted care for patients.

Nutrition Pearls for EDS & Cognitive Hypnotherapy

  • Bile acid malabsorption is a common cause of diarrhea, especially in patients with IBS and those with IBD that is otherwise well managed
  • Bile acid diarrhea can greatly impact quality of life and result in urgency, incontinence and frequent trips to the bathroom
  • Currently SEHCAT testing is not readily available, in addition it is quite labor intensive. As such most clinicians empirically treat.
  • Due to the chronicity of BAD and the medication often being difficult to take, compliance can be low, and management can be difficult for patients
  • A novel test, C4 testing (7α-hydroxy-4-cholesten-3-one), is a simple serum marker of BAD that can be used in the diagnosis of BAD in patients with IBS and IBD

Robert J. Battat, M.D. is an expert in inflammatory bowel disease specializing in Crohn’s Disease and Ulcerative Colitis. He is an Assistant Attending Physician at the New York-Presbyterian Hospital/Weill Cornell Medicine and the Jill Roberts Center for Inflammatory Bowel Disease.    

Dr. Battat obtained his medical degree and completed both his internal medicine residency training and clinical gastroenterology fellowship at McGill University in Montreal, Canada. He subsequently completed a clinical and research fellowship in inflammatory bowel disease at the University of California, San Diego and at Robarts Clinical Trials under Dr. William Sandborn and Dr. Brian Feagan.      

He has a major interest in personalized medicine in inflammatory bowel disease and has extensively published scientific articles on this topic. This includes the development of a serum tess to diagnose bile acid malabsorption -which leads well into our topic today!

Dr Battat and I discuss:

  • What is bile acid diarrhea? 
  • How does bile acid diarrhea develop?
  • How is it diagnosed? 
    • SEHCAT Test
    • Therapeutic trial
    • C4 Testing as a measurement for precursor to bile acids
  • Is it a common cause of unexplained diarrhea in your practice?
  • How is BAD managed? 
  • Do you often see an overlap between BAD and IBS? IBD & BAD? 
  • Where the research is going with BAD diagnosis and management and what can patients and health care providers expect?

You can read Dr. Battat’s research here:

Battat, R., Duijvestein, M., Casteele, N. V., Singh, S., Dulai, P. S., Valasek, M. A., … & Jain, A. (2019). Serum Concentrations of 7α-hydroxy-4-cholesten-3-one are Associated with Bile Acid Diarrhea in Patients with Crohn’s Disease. Clinical Gastroenterology and Hepatology17(13), 2722-2730.

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