Impact of Bile Acid Diarrhea in Patients With Diarrhea-Predominant Irritable Bowel Syndrome on Symptoms and Quality of Life

Joelle BouSaba, Wassel Sannaa, Sanna McKinzie, Priya Vijayvargiya, Victor Chedid, Xiao Jing Wang, Jessica Atieh, Ting Zheng, Justin Brandler, Ann L. Taylor, Irene Busciglio, W. Scott Harmsen, Michael Camilleri

Research output: Contribution to journalArticlepeer-review


Background & Aims: Bile acid diarrhea (BAD) affects approximately a quarter of patients with irritable bowel syndrome with diarrhea (IBS-D). We aimed to compare the demographics, bowel and somatic symptoms, and quality of life of patients with IBS-D, with or without BAD. Methods: On one occasion, patients with IBS-D (positive for Rome III criteria) completed the following questionnaires: bowel disease questionnaire, Hospital Anxiety and Depression inventory, general quality of life (Symptom Checklist-90), and IBS-specific quality of life. A fasting serum C4 level higher than 52.5 ng/mL was used as a biomarker for BAD. Statistical analysis included a multiple variable logistic model to identify strong predictors of BAD in IBS-D. Results: Among 219 patients (79% female) with IBS-D, 44 had BAD; the BAD group was significantly older and had a higher body mass index than the patients without BAD. Patients with BAD had more severe bowel dysfunction and impact on IBS-specific quality of life (need of toilet proximity) compared with patients with IBS-D without BAD. Patients with BAD were more likely than other IBS-D groups to receive antidiarrheals, bile acid binders, and antacid secretory agents. The severity of diarrhea and need of toilet proximity were predictors of BAD in IBS-D (P < .01). Patients with BAD were more likely to have a depression score higher than 8 on the Hospital Anxiety and Depression inventory. Conclusions: There is a greater impact on bowel and somatic symptoms and quality of life in IBS-D with BAD compared with IBS-D without BAD. Screening for BAD in IBS-D is especially relevant, with more severe and frequent diarrhea along with urgency.

Original languageEnglish (US)
Pages (from-to)2083-2090.e1
JournalClinical Gastroenterology and Hepatology
Issue number9
StatePublished - Sep 2022


  • Depression
  • Malabsorption
  • Somatization

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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