Measurement of serum 7a-hydroxy-4-cholesten-3-one as a marker of bile acid malabsorption in dogs with chronic diarrhoea: a pilot study

Kent, A. C. C.; Cross, G.; Taylor, D. R.; Sherwood, R. A.; Watson, P. J.

A number of potential treatments exist for bile acid malabsorption if it is identified or suspected. Glucocorticoids have been shown to upregulate the bile acid transporter apical sodium linked bile acid transporter (ASBT) in people (Johnston and others 2011), which may explain the positive response to these medications in many cases. Glucocorticoids form the mainstay of immunosuppressive treatment in inflammatory intestinal diseases and may be treating bile acid malabsorption as a useful side effect of therapy. The bile acid sequestrant cholestyramine is the first-line treatment in most people with bile acid malabsorption and is effective in between 63 and 100 per cent of people in different studies (Wilcox and others 2014) . This has been used successfully in both dogs and cats; however, it is not licensed in either of these species. An alternative sequestrant is colesevelam, which has shown benefit in patients who were intolerant or unresponsive to cholestyramine (Beigel and others 2014) . However, to the authors' knowledge, colesevelam has not been used on canine patients. It is likely that dietary management is also important in managing these cases. Increasing dietary fat has been shown to increase faecal bile acid secretion in people (Koga and others 1984) , and therefore, a low-fat diet is probably preferred (Westergaard 2007) .