Журнал "Гастроэнтерология" Том 60, №3, 2026

Однією з частих, але недодіагностованих і недооцінених причин хронічної діареї є мальабсорбція жовчних кислот (ЖК), яка наявна в 1 % світової популяції, зокрема в половини пацієнтів з розладами осі «кишечник — мозок» — синдромом подразненого кишечника з діареєю (СПК-Д) і функціональною діареєю (ФД). Незважаючи на існування низки діагностичних тестів для верифікації діареї ЖК (ДЖК; у деяких джерелах використовується термін «хологенна діарея»), більшість з них є недоступними для практичних лікарів у всьому світі, зокрема в Україні. Тому емпіричне призначення секвестрантів жовчних кислот, а саме холестираміну, є найбільш оптимальною та доцільною опцією, яка одночасно є діагностичним і лікувальним заходом. На жаль, недостатня обізнаність щодо частоти, причин та алгоритмів ведення пацієнтів з імовірною ДЖК призводить до незадовільних результатів лікування пацієнтів із хронічною діареєю та подальшого зниження якості їхнього життя. Тому в даній статті ми зробили огляд літератури з питань поширеності, механізмів розвитку, чинників ризику ДЖК, а також діагностичних і лікувальних можливостей в умовах реальної щоденної практики в Україні.

One of the common, but underdiagnosed and underestimated causes of chronic diarrhea is bile acid malabsorption, which is present in 1 % of the world’s population, including half of patients with disorders of the gut-brain axis — irritable bowel syndrome with diarrhea and functional diarrhea. Despite the existence of seve­ral diagnostic tests for the verification of bile acid diarrhea (BAD) (some sources use the term “chologenic diarrhea”), most of them are inaccessible to practicing physicians worldwide, including in Ukraine. Therefore, the empirical prescription of bile acid sequestrants, namely cholestyramine, is the most optimal and appropriate option, which is simultaneously a diagnostic and therapeutic intervention. Unfortunately, little awareness of the frequency, causes and algorithms for managing patients with probable BAD leads to unsa­tisfactory treatment outcomes in patients with chronic diarrhea and a further decrease in their quality of life. Therefore, in this article, we conducted a literature review that reveals the issues of prevalence, mechanisms of development, risk factors of BAD, as well as diagnostic and treatment options in real daily practice in Ukraine.

огляд; жовчні кислоти; хронічна діарея; діарея жовчних кислот; секвестранти жовчних кислот; холестирамін

1. Arasaradnam RP, Brown S, Forbes A, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut. 2018;67(8):1380-1399. doi: 10.1136/gutjnl-2017-315909.
2. Ihara E, Manabe N, Ohkubo H, et al. Evidence-Based Clinical Guidelines for Chronic Diarrhea 2023. Digestion. 2024;105(6):480-497. doi: 10.1159/000541121.
3. Singh P, Mitsuhashi S, Ballou S, et al. Demographic and Dietary Associations of Chronic Diarrhea in a Representative Sample of Adults in the United States. Am J Gastroenterol. 2018;113(4):593-600. doi: 10.1038/ajg.2018.24.
4. Meisenheimer ES, Epstein C, Thiel D. Acute Diarrhea in Adults. Am Fam Physician. 2022;106(1):72-80.
5. Descoteaux-Friday GJ, Shrimanker I. Chronic Diarrhea. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK544337.
6. Törnblom H, Simrén M. Mistakes in the management of unexplained diarrhoea and how to avoid them. UEG Education. 2022;22:16-19.
7. Hiner GE, Walters JR. A practical approach to the patient with chronic diarrhoea. Clin Med (Lond). 2021;21(2):124-126. doi: 10.7861/clinmed.2021-0028.
8. Fernández-Bañares F, Accarino A, Balboa A, et al. Diarrea crónica: definición, clasificación y diagnóstico [Chronic diarrhoea: Definition, classification and diagnosis]. Gastroenterol Hepatol. 2016;39(8):535-559. doi: 10.1016/j.gastrohep.2015.09.018.
9. Camilleri M. Bile Acid diarrhea: prevalence, pathogenesis, and therapy. Gut Liver. 2015;9(3):332-339. doi: 10.5009/gnl14397.
10. Kårhus ML, Ellegaard AM, Winther-Jensen M, Hansen S, Knop FK, Kårhus LL. The Epidemiology of Bile Acid Diarrhea in Denmark. Clin Epidemiol. 2023;15:1173-1181. doi: 10.2147/CLEP.S442054.
11. Flores V, Martínez-Lozano H, Bighelli F, et al. Prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics: a prospective study. BMC Gastroenterol. 2021;21(1):56. doi: 10.1186/s12876-021-01637-4.
12. Shiha MG, Ashgar Z, Fraser EM, Kurien M, Aziz I. High prevalence of primary bile acid diarrhoea in patients with functional diarrhoea and irritable bowel syndrome-diarrhoea, based on Rome III and Rome IV criteria. EClinicalMedicine. 2020;25:100465. doi: 10.1016/j.eclinm.2020.100465.
13. Camilleri M, BouSaba J. New Developments in Bile Acid Diarrhea. Gastroenterol Hepatol (N Y). 2023;19(9):520-537.
14. Di Ciaula A, Garruti G, Lunardi Baccetto R, et al. Bile Acid Physiology. Ann Hepatol. 2017;16(Suppl. 1: s3-105.):s4-s14. doi: 10.5604/01.3001.0010.5493
15. Chiang JYL, Ferrell JM. Bile Acids as Metabolic Regulators and Nutrient Sensors. Annu Rev Nutr. 2019;39:175-200. doi: 10.1146/annurev-nutr-082018-124344.
16. Stellaard F, Lütjohann D. Dynamics of the enterohepatic circulation of bile acids in healthy humans. Am J Physiol Gastrointest Liver Physiol. 2021;321(1):G55-G66. doi: 10.1152/ajpgi.00476.2020.
17. Guzior DV, Quinn RA. Review: microbial transformations of human bile acids. Microbiome. 2021;9(1):140. Published 2021 Jun 14. doi: 10.1186/s40168-021-01101-1.
18. Ticho AL, Malhotra P, Dudeja PK, Gill RK, Alrefai WA. Bile Acid Receptors and Gastrointestinal Functions. Liver Res. 2019;3(1):31-39. doi: 10.1016/j.livres.2019.01.001.
19. Min YW, Rezaie A, Pimentel M. Bile Acid and Gut Microbiota in Irritable Bowel Syndrome. Journal of neurogastroenterology and motility. 2022;28(4):549-561. https://doi.org/10.5056/jnm22129.
20. Alemi F, Poole DP, Chiu J, et al. The receptor TGR5 mediates the prokinetic actions of intestinal bile acids and is required for normal defecation in mice. Gastroenterology. 2013;144(1):145-154. doi: 10.1053/j.gastro.2012.09.055.
21. Camilleri M, Vijayvargiya P. The Role of Bile Acids in Chronic Diarrhea. Am J Gastroenterol. 2020;115(10):1596-1603. doi: 10.14309/ajg.0000000000000696.
22. Barbara G, Bellini M, Portincasa P, et al. Bile acid diarrhea in patients with chronic diarrhea. Current appraisal and recommendations for clinical practice. Dig Liver Dis. 2025;57(3):680-687. doi: 10.1016/j.dld.2024.12.019.
23. Ticho AL, Malhotra P, Dudeja PK, Gill RK, Alrefai WA. Intestinal Absorption of Bile Acids in Health and Disease. Compr Physiol. 2019;10(1):21-56. doi: 10.1002/cphy.c190007.
24. Marasco G, Cremon C, Barbaro MR, et al. Pathophysio–logy and Clinical Management of Bile Acid Diarrhea. J Clin Med. 2022;11(11):3102. doi: 10.3390/jcm11113102.
25. Chang C, Jiang J, Sun R, Wang S, Chen H. Downregulation of Serum and Distal Ileum Fibroblast Growth Factor19 in Bile Acid Diarrhoea Patients. Dig Dis Sci. 2022;67(3):872-879. doi: 10.1007/s10620-021-07042-x.
26. Xu Y, Jing H, Wang J, et al. Disordered Gut Microbiota Correlates With Altered Fecal Bile Acid Metabolism and Post-cholecystectomy Diarrhea. Front Microbiol. 2022;13:800604. doi: 10.3389/fmicb.2022.800604.
27. Di Ciaula A, Khalil M, Baffy G, Portincasa P. Advances in the pathophysiology, diagnosis and management of chronic diarrhoea from bile acid malabsorption: a systematic review. Eur J Intern Med. 2024;128:10-19. doi: 10.1016/j.ejim.2024.07.008.
28. Camilleri M. BAD on the Runs: Improved Diagnosis of Idiopathic Bile Acid Diarrhea. Dig Dis Sci. 2022;67(3):745-747. doi: 10.1007/s10620-021-07044-9.
29. Vijayvargiya P, Gonzalez Izundegui D, Calderon G, Tawfic S, Batbold S, Camilleri M. Fecal Bile Acid Testing in Assessing Patients With Chronic Unexplained Diarrhea: Implications for Healthcare Utilization. Am J Gastroenterol. 2020;115(7):1094-1102. doi: 10.14309/ajg.0000000000000637.
30. Ruiz-Campos L, Gisbert JP, Ysamat M, et al. Systematic review with meta-analysis: the prevalence of bile acid malabsorption and response to colestyramine in patients with chronic watery diarrhoea and previous cholecystectomy. Aliment Pharmacol Ther. 2019;49(3):242-250. doi: 10.1111/apt.15099.
31. Asad U, Wang CF, Jones MW. Laparoscopic Cholecystectomy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 2, 2025.
32. Bannaga A, Kelman L, O’Connor M, Pitchford C, Walters JR, Arasaradnam RP. How bad is bile acid diarrhoea: an online survey of patient-reported symptoms and outcomes. BMJ Open Gastroenterol. 2017;4(1):e000116. doi: 10.1136/bmjgast-2016-000116.
33. Sciumè GD, Berti G, Lambiase C, et al. Misinterpreting Diarrhea-Predominant Irritable Bowel Syndrome and Functional Diarrhea: Pathophysiological Highlights. J Clin Med. 2023;12(18):5787. doi: 10.3390/jcm12185787.
34. Hughes LE, Ford C, Brookes MJ, Gama R. Bile acid diarrhoea: Current and potential methods of diagnosis. Ann Clin Biochem. 2021;58(1):22-28. doi: 10.1177/0004563220966139.
35. Lyutakov I, Ursini F, Penchev P, et al. Methods for diagnosing bile acid malabsorption: a systematic review. BMC Gastroenterol. 2019;19(1):185. doi: 10.1186/s12876-019-1102-1.
36. Kårhus ML, Brønden A, Forman JL, et al. Safety and efficacy of liraglutide versus colesevelam for the treatment of bile acid diarrhoea: a randomised, double-blind, active-comparator, non-inferiority clini–cal trial. Lancet Gastroenterol Hepatol. 2022;7(10):922-931. doi: 10.1016/S2468-1253(22)00198-4.
37. Battat R, Duijvestein M, Vande Casteele N, et al. Serum Concentrations of 7α-hydroxy-4-cholesten-3-one Are Associated With Bile Acid Diarrhea in Patients With Crohn's Disease. Clin Gastroenterol Hepatol. 2019;17(13):2722-2730.e4. doi: 10.1016/j.cgh.2018.11.012.
38. Pattni SS, Brydon WG, Dew T, et al. Fibroblast growth factor 19 in patients with bile acid diarrhoea: a prospective comparison of FGF19 serum assay and SeHCAT retention. Aliment Pharmacol Ther. 2013;38(8):967-976. doi: 10.1111/apt.12466.
39. Vijayvargiya P, Camilleri M, Chedid V, et al. Analysis of Fecal Primary Bile Acids Detects Increased Stool Weight and Colonic Transit in Patients With Chronic Functional Diarrhea. Clin Gastroenterol Hepatol. 2019;17(5):922-929.e2. doi: 10.1016/j.cgh.2018.05.050.
40. Polishchuk S, Neverovskyi A, Shypulin V. Alterations of bile acid metabolism in patients with functional bowel disorders: a case-control study. Prz Gastroenterol. 2023;18(4):442-448. doi: 10.5114/pg.2023.133062.
41. Smalley W, Falck-Ytter C, Carrasco-Labra A, Wani S, Lytvyn L, Falck-Ytter Y. AGA Clinical Practice Guidelines on the Labo–ratory Evaluation of Functional Diarrhea and Diarrhea-Predominant Irritable Bowel Syndrome in Adults (IBS-D). Gastroenterology. 2019;157(3):851-854. doi: 10.1053/j.gastro.2019.07.004.
42. Savarino E, Zingone F, Barberio B, et al. Functional bowel disorders with diarrhoea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility. United European Gastroenterol J. 2022;10(6):556-584. doi: 10.1002/ueg2.12259.
43. Lenti MV, Hammer HF, Tacheci I, et al. European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN. Part 1: Definitions, Clinical Phenotypes, and Diagnostic Testing for Malabsorption. United European Gastroenterol J. 2025;13(4):599-613. doi: 10.1002/ueg2.70012.
44. Corsetti M, Shin A, Lacy BE, et al. Bowel Disorders. Gastroenterology. 2026;170(6):1261-1282. doi: 10.1053/j.gastro.2026.02.003.
45. Sadowski DC, Camilleri M, Chey WD, et al. Canadian Association of Gastroenterology Clinical Practice Guideline on the Management of Bile Acid Diarrhea. Clin Gastroenterol Hepatol. 2020;18(1):24-41.e1. doi: 10.1016/j.cgh.2019.08.062.
46. Wilcox C, Turner J, Green J. Systematic review: the mana–gement of chronic diarrhoea due to bile acid malabsorption. Aliment Pharmacol Ther. 2014;39(9):923-939. doi: 10.1111/apt.12684.
47. Polishchuk S, Neverovskyi A. Efficacy of bile salt hydrolase synthesizing probiotic bacteria in the treatment of irritable bowel syndrome with diar–rhea. GASTRO [Internet]. 2023 Jun. 22 [cited 2026 Jun. 16];57(2):108-14. https://gastro-journal.com/index.php/journal/article/view/540.
48. Інструкція для медичного застосування лікарського засобу пмс-Холестирамін регулар зі смаком апельсина. Державний реєстр лікарських засобів. 2006.
49. Schiepatti A, Bossert I, Cincotta M, et al. Comparison between SeHCAT test and clinical response to cholestyramine in patients with chronic diarrhea and high suspicion of bile acid malabsorption: A single-center prospective study. J Dig Dis. 2024;25(5):279-284. doi: 10.1111/1751-2980.13289.
50. Merza N, Saab O, Nawras Y, et al. Evaluation of Alternative Treatment Strategies for Bile Acid Malabsorption in Inflammatory Bowel Disease Patients: A Network Meta-Analysis. J Clin Med Res. 2024;16(2-3):33-45. doi: 10.14740/jocmr5007.