Bile Acid Malabsorption and Its Potential Links to Radiation Therapy: Understanding and Management

Radiation therapy has long been hailed as a powerful weapon in our fight against cancer. However, beyond its life-saving benefits, I have come to learn about the lesser-known potential side effects that can emerge after treatment. One such side effect that personally impacted my quality of life is bile acid malabsorption (BAM). In this blog, I want to share my own experience and explore the intriguing connection between radiation therapy and BAM.

In 2006, I received the devastating news of my cervical cancer diagnosis. After undergoing treatment, I believed the worst was behind me. However, in 2011, I started experiencing late-stage effects that were suspected to be Chronic Radiation Enteritis. I was faced with distressing symptoms such as flatus, bowel incontinence, and excruciating cramps. Determined to manage these symptoms, I embarked on a journey of dietary changes, including a low FODMAP, lactose-free, low-fibre, and low-fructose diet. I even avoided fruit and vegetable skins, popcorn and nuts.

Over the years, my condition deteriorated, and I sought support by sharing my history and symptoms on a Facebook group dedicated to Radiation Disease in 2022. It was there that I encountered a response from a former cervical cancer survivor who shared similar symptoms. She underwent a SeHCAT test, which confirmed BAM. Her life was transformed after starting a bile acid binder called Cholestyramine.

However, I faced a roadblock in my quest for a diagnosis and suitable treatment. Testing for BAM was not currently available in Australia, which prolonged my search for answers. Finally, in 2023, I was able to commence a trial of Cholestyramine. To my relief, within 48 hours, my acid levels reduced, and my stools approached normalcy. The benefits were not limited to physical improvements; I experienced increased energy and a renewed zest for life.

Unfortunately, a subsequent colonoscopy revealed a stricture, and my doctor had to cancel the trial due to the risk of a bowel obstruction. I strongly believe that if BAM had been detected earlier, Cholestyramine would have had a substantial life-changing benefit for me. Inspired by my personal journey, I aim to raise awareness about the potential late effects of radiation therapy for cancer survivors. I urge fellow survivors to seek early detection and appropriate treatment to improve their quality of life.Shreddies Australia is committed to providing contracted service rates to whole of government providers and organisation who deliver supports or services which are aimed at improving the lives of persons living with Disability and our Senior citizens.  If you provide these services, we want to help, reach out to us and let us know how we can best support you.

Radiation therapy, while essential in our fight against cancer, can bring forth unexpected challenges such as bile acid malabsorption. My personal journey sheds light on the often-overlooked late effects of radiation therapy and emphasizes the importance of early detection and treatment. By sharing my story, I hope to create awareness among fellow survivors and empower them to proactively seek support and interventions that can significantly improve their quality of life. Join me as we delve deeper into the connection between radiation therapy and BAM, offering insights, guidance, and hope for a better tomorrow.

Understanding Bile Acid Malabsorption (BAM)

Bile acids are produced by the liver and play a vital role in the digestion and absorption of fats from our diet. They aid in the breakdown of fats and facilitate the absorption of fat-soluble vitamins. Bile acids are normally reabsorbed in the terminal ileum, the last part of the small intestine, and recycled back to the liver through the enterohepatic circulation.

However, in some individuals, this reabsorption process may be impaired, leading to bile acid malabsorption. BAM occurs when there is an excessive amount of bile acids reaching the colon. The excess bile acids can cause irritation and inflammation, resulting in various gastrointestinal symptoms.

Symptoms of Bile Acid Malabsorption

The symptoms of bile acid malabsorption can vary from person to person but commonly include:

  • Diarrhea: Frequent, watery stools are a hallmark symptom of BAM. The diarrhea may be urgent, often accompanied by abdominal pain and cramping.
  • Abdominal discomfort: Many individuals with BAM experience abdominal pain, bloating, and excessive gas.
  • Faecal urgency: BAM can cause a sudden, compelling urge to have a bowel movement, which can be challenging to control.
  • Fat malabsorption: Since bile acids play a role in fat digestion, their malabsorption can lead to steatorrhea, which is the passage of pale, greasy stools.
  • Foul smelling flatulence: Excess bile acids in the colon can contribute to the production of foul-smelling gas, leading to offensive-smelling flatulence.

Possible Links to Radiation Therapy

Radiation therapy can cause damage to the gastrointestinal tract, particularly to the lining of the small intestine. This damage can disrupt the normal functioning of the intestinal cells responsible for bile acid reabsorption, potentially leading to bile acid malabsorption.

While limited research has directly explored the relationship between radiation therapy and BAM, some studies have suggested an association. The exact mechanisms underlying this link remain unclear, but it is hypothesized that radiation-induced inflammation and changes in the gut microbiota may contribute to the development of bile acid malabsorption.

Management and Treatment

The management and treatment of bile acid malabsorption typically involve medical interventions such as bile acid binders, anti-diarrheal medications, and dietary modifications, as mentioned earlier. These approaches aim to alleviate symptoms, reduce excess bile acids in the colon, and improve overall digestive health.

If you suspect bile acid malabsorption, it is essential to consult with a healthcare professional for an accurate diagnosis. The diagnosis often involves a combination of medical history, physical examination, and specialized tests, such as a SeHCAT scan or faecal bile acid measurement.

Treatment options for BAM aim to alleviate symptoms and reduce the excess bile acids reaching the colon. They may include:

  • Bile acid binders: Medications such as cholestyramine or colesevelam can bind to bile acids, preventing their reabsorption and reducing their levels in the colon.
  • Anti-diarrheal medications: Medications like loperamide may be prescribed to help control diarrhea and improve stool consistency.
  • Dietary modifications: Adjusting the diet to include low-fat, low-fibre foods and avoiding trigger foods can be helpful. Some individuals may also benefit from a reduced intake of foods high in bile acids, such as certain types of fats.

In addition to medical interventions and dietary modifications, there are some products available, such as Shreddies garments, that may help manage the odour associated with flatulence. Shreddies is a brand that offers specialized underwear and other garments with activated carbon filters designed to absorb and neutralize odours. By wearing Shreddies garments, individuals experiencing bad flatulence can eliminate odour and feel more confident in social situations.

Proper diagnosis and management of BAM are essential for effective treatment. This may include medical interventions such as bile acid binders, anti-diarrheal medications, and dietary modifications. While Shreddies garments can help manage the odour associated with flatulence, it is important to note that they do not directly address the underlying causes of BAM or serve as a Bile Acid Malabsorption treatment option.

If you suspect bile acid malabsorption or any gastrointestinal condition, it is crucial to consult with a healthcare professional. They can provide an accurate diagnosis, explore potential underlying causes, and recommend appropriate treatment options tailored to your specific needs.

Remember, managing bile acid malabsorption involves a multidisciplinary approach, including medical intervention, dietary modifications, and lifestyle changes. By working closely with healthcare professionals, individuals with BAM can find relief from symptoms and improve their overall well-being.

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