inability to absorb bile acids in the distal ileum resulting in diminished bile acid pool
e.g. ileal resection or Crohn disease of the ileum
deconjugation of bile acids
e.g., small intestinal bacterial overgrowth (SIBO)
Symptoms
Pale, bulky stools
Frothy or greasy stools
Foul odor to stool
Weight loss with nutritional deficiency
Resolves within 1-2 days of not eating
Excessive Flatus
Evaluation
fecal elastase
celiac screen
stool chymotrypsin level
Complications
Weight loss in adults and other consequences of malnutrition such as increased susceptibility to infections, and increased morbidity and mortality from various disease states. Additionally, in children, malnutrition results in growth failure and poor neurological development
Deficiencies of fat-soluble vitamins (A, D, E, and K)
Poor bone health resulting in osteopenia, osteoporosis, and fractures (CF, celiac disease)
Iron deficiency anemia, zinc deficiency (celiac disease)
Dermatitis herpetiformis, non-Hodgkin lymphoma, adenocarcinoma of the upper gastrointestinal tract (celiac disease)
Megaloblastic anemia due to B12 deficiency (in terminal ileum disease and SIBO)