Is Fodzyme effective for treating bile acid malabsorption?

Fodzyme is Not Recommended for Bile Acid Malabsorption Treatment

Fodzyme is not recommended for the treatment of bile acid malabsorption (BAM), as bile acid sequestrants like cholestyramine, colestipol, or colesevelam remain the first-line therapy with established evidence for this condition. 1

Understanding Bile Acid Malabsorption

Bile acid malabsorption is a condition characterized by:

• Excessive bile acids entering the colon due to impaired reabsorption in the terminal ileum
• Resulting in watery diarrhea, urgency, and abdominal discomfort
• Common causes include ileal resection, Crohn's disease, radiation enteritis, or idiopathic factors

Evidence-Based Treatment Algorithm for BAM

First-Line Treatment

1. Bile Acid Sequestrants:

   • Cholestyramine (first choice due to clinical experience and cost) 1
   • Response rates with cholestyramine: 56-70% of patients 1, 2
   • Dosing: Start with low dose and titrate based on response

2. Alternative Bile Acid Sequestrants (if cholestyramine not tolerated):

   • Colesevelam (better tolerated, stronger binding affinity) 1
   • Colestipol 1
   • Response rates with alternative sequestrants: 47-67% 1

Adjunctive Measures

• Low-fat diet for patients with more severe BAM 3
• Loperamide for additional symptom control 1

Why Fodzyme is Not Recommended

Fodzyme is not mentioned in any clinical guidelines or research evidence for bile acid malabsorption. The Canadian Association of Gastroenterology, British Society of Gastroenterology, and other authoritative guidelines specifically recommend bile acid sequestrants as the established treatment for BAM 1.

Important Clinical Considerations

• Diagnostic Testing: SeHCAT scan can confirm BAM when diagnosis is uncertain, but a therapeutic trial of bile acid sequestrants is often appropriate 1
• Treatment Challenges: 11% of patients find cholestyramine intolerable due to unpalatability or side effects 1
• Common Side Effects: Abdominal bloating, pain, dyspepsia, nausea, flatulence, constipation 1
• Treatment Duration: Some patients (approximately 50%) may experience spontaneous remission over time 4
• Severity Matters: Patients with mild to moderate BAM typically respond well to bile acid sequestrants, while those with severe BAM and steatorrhea may require additional dietary modifications 3

Special Populations

For patients with irritable bowel syndrome with diarrhea who have atypical features (nocturnal diarrhea, prior cholecystectomy), BAM should be considered and treated with bile acid sequestrants if confirmed 1.

For patients with Crohn's disease who have undergone ileal resection, bile acid sequestrants are strongly recommended for diarrhea suggestive of BAM 1.

The evidence clearly supports the use of established bile acid sequestrants for BAM treatment, with no evidence supporting Fodzyme for this specific condition.