An opportunity for integrative approaches: an examination of the perspectives of women with Bile acid malabsorption (BAM)

Background
The aim was to explore experiences of individuals with the controversial conditions bile acid diarrhoea (BAD) and bile acid malabsorption (BAM). BAD/BAM are poorly understood, misdiagnosis is common and there is evidence that around a third of patients with Irritable Bowel Syndrome (diarrhoea) (IBS-D) may have BAD/BAM.

Methods
In depth, semi-structured interviews were undertaken with six participants, all female, 18 + years old and living in the UK. All had been diagnosed with BAD/BAM for at least one year. Interviews were recorded and transcribed verbatim. Data was coded and thematic analysis was undertaken using grounded theory.

Results
Six main themes emerged including 1. triggers, and how to control symptoms; 2. experience of diagnosis/care and associated delays; 3. psychosocial impact of the condition, this specifically identified impacts on mental health; 4. the signs and symptoms; 5. comorbidities and other health problems and finally 6. self-education/learning for management of BAD/BAM. Findings indicate that BAD and BAM are often poorly understood; and patients experience delays with diagnosis and moreover that the condition has profound effects on the lives of patients including impacting on mental health. A low-fat diet was identified as useful in managing symptoms, however participants had concerns over absorption of fat-soluble vitamins such as vitamin D and often experienced fatigue.

Conclusion
Further research is recommended to understand both the psychosocial and nutritional impacts of BAD/BAM and to understand the management strategies of patients and the potential role of integrative medicine in caring for this group.