Crohn's Disease Question

[QofQuimica]

Can one of you GI gurus please explain to me why you would give bile acid sequestrants like cholestyramine or colestipol to CD patients? It doesn't make sense to me that you'd give a drug that further prevents bile acid reabsorption to a person who already has terminal ileum disease and difficulty absorbing bile acids! But I have a book that says a bile acid sequestrant is a CD treatment, so I'd just like to know what I'm missing here. Thanks in advance.

Edit: In case anyone else is also wondering, I found the answer to my question on emedicine. It turns out that people with CD can have secretory diarrhea because of their inability to reabsorb bile *acids*. If they mainly have terminal ileal disease, the bile acid sequestrants help reduce their diarrhea by binding up the bile acids in the colon. But if they have extensive ileal disease, then they are unable to absorb bile *salts*, and the bile acid sequestrants will make the diarrhea even worse.

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[dragonfly99]

You got it. good little medical student

I'm studying for internal medicine boards, and I had a similar question. Apparently this (diarrhea secondary to too many vs. too few bile acids) occurs s/p ileal surgery too. If <100cm ileum lost, you can get diarrhea from too many bile salts being around, but if >100 cm resected then you can get diarrhea from not enough, since if you are missing >100cm of terminal ileum you don't reabsorb enough bile salts...OK then. I was just wondering what if you lost exactly 100cm...ha ha.

 

[QofQuimica]

You got it. good little medical student

I'm studying for internal medicine boards, and I had a similar question. Apparently this (diarrhea secondary to too many vs. too few bile acids) occurs s/p ileal surgery too. If <100cm ileum lost, you can get diarrhea from too many bile salts being around, but if >100 cm resected then you can get diarrhea from not enough, since if you are missing >100cm of terminal ileum you don't reabsorb enough bile salts...OK then. I was just wondering what if you lost exactly 100cm...ha ha.

Did I just get e-patted on the head??? Thanks for confirming what I found.

Probably if you lose exactly 100 cm of ileum then the bile salts and bile acids will exactly balance each other out and you'll be fine.