TAKE HOME POINTS
1.Bile acid Diarrhea (BAD) may occur after terminal ileum resection due to bile acid malabsorption. Empiric trial of a bile acid binder may help symptoms.
2.Intrinsic Factor bound Vitamin B 12 is absorbed in the terminal ileum. Some months after terminal ileum resection patients may develop Vitamin B12 deficiency and should be monitored for this. Treatment is with IM or intranasal Vitamin B 12
REFERENCES:
•Carroll RE, Benedetti E, Schowalter JP, Buchman AL. Management and Complications of Short Bowel Syndrome: an Updated Review. Curr Gastroenterol Rep. 2016;18(7):40.
•Barkun AN, Love J, Gould M, Pluta H, Steinhart H. Bile acid malabsorption in chronic diarrhea: pathophysiology and treatment. Can J Gastroenterol. 2013 Nov;27(11):653-9. PMID: 24199211; PMCID: PMC3816948.
•Park YE, Park SJ, Park JJ, Cheon JH, Kim T, Kim WH. Incidence and risk factors of micronutrient deficiency in patients with IBD and intestinal Behçet’s disease: folate, vitamin B12, 25-OH-vitamin D, and ferritin. BMC Gastroenterol. 2021;21(1):32. Published 2021 Jan 21.
•Langan RC, Goodbred AJ. Vitamin B12 Deficiency: Recognition and Management. Am Fam Physician. 2017;96(6):384-389.
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