From the Guidelines
Low bile production can cause several digestive symptoms, including light-colored or clay-colored stools, digestive discomfort, bloating, gas, abdominal pain, nausea, vomiting, fat malabsorption, jaundice, itchy skin, and vitamin deficiencies. The symptoms of low bile production can be identified through various diagnostic approaches, including increases in serum alkaline phosphatase (AP) and c-glutamyltranspeptidase (cGT) levels, followed by conjugated hyperbilirubinemia at more advanced stages 1. Some common signs of low bile production include:
- Light-colored or clay-colored stools
- Digestive discomfort, particularly after eating fatty foods
- Bloating, gas, and abdominal pain
- Nausea and vomiting, especially after meals
- Fat malabsorption, leading to greasy, foul-smelling stools that float (steatorrhea) and unexplained weight loss
- Jaundice (yellowing of skin and eyes) when bile flow is severely restricted
- Itchy skin (pruritus) resulting from bile salts accumulating in the bloodstream
- Vitamin deficiencies, particularly fat-soluble vitamins (A, D, E, and K), due to poor absorption The diagnostic approach to cholestasis, which is an impairment of bile formation and/or bile flow, involves testing for serum antimitochondrial antibodies (AMA) and performing a liver biopsy if necessary 1. Treatment depends on the underlying cause, which might include gallbladder issues, liver disease, or bile duct blockages, and may involve medications like ursodeoxycholic acid to improve bile flow, bile acid supplements like cholestyramine to manage symptoms, and dietary changes to reduce fat intake and eat smaller, more frequent meals. It is essential to evaluate the patient with cholestasis using a general algorithm that includes testing for AMA, performing a liver biopsy, and considering genetic testing for ABCB4 when available 1. In adult patients with chronic intrahepatic cholestasis, the next step is testing for serum antimitochondrial antibodies (AMA) since the diagnosis of primary biliary cirrhosis (PBC) can be made with confidence in a patient with high-titer AMA and a cholestatic serum enzyme profile in the absence of an alternative explanation 1. A liver biopsy should be considered in patients with otherwise unexplained intrahepatic cholestasis and a negative AMA test 1. Genetic testing for ABCB4, when available, should be considered in patients with a negative AMA test and biopsy findings that might be compatible with PBC or primary sclerosing cholangitis (PSC) 1.
From the Research
Symptoms of Low Bile
- Diarrhea
- Steatorrhea
- Weight loss
- Flatulence
- Postprandial abdominal pain 2
- Nongastrointestinal manifestations can include elevated levels of liver function markers, anemia, skin conditions, infertility, and bone disease 2
Associated Conditions
- Lactose intolerance
- Celiac disease
- Exocrine pancreatic insufficiency 2
- Nonalcoholic steatohepatitis (NASH) 3, 4
- Fatty liver disease 4