Bile-Acid Malabsorption

To the Editor.—  We read the stimulating report by Hutcheon et al (241:823, 1979) concerning observation of bile-acid malabsorption in three postcholecystectomy patients and the response to cholestyramine therapy. Our group has reported a similar experience^1-3 in three postcholecystectomy patients in whom bile-acid malabsorption was shown by studies using the bile-acid breath test and the measurement of fecal excretion of radioactively labeled bile acids. In two of these three patients, the diarrhea responded to cholestyramine. We termed this entity "Type 3" bile-acid diarrhea, with "Type 1" being found in diseases or after resection of terminal ileum, and "Type 2" being defined as a defect of active ileal bile-acid transport in the absence of ileal disease or resection.⁴We believe that among the possible mechanisms that could be responsible for bile-acid diarrhea after cholecystectomy, an ileal transport defect is the most likely. Increased demands on the bile-acid transport system, resulting