Obeticholic acid for severe bile acid diarrhea with intestinal failure: A case report and review of the literature

Table 2 Anti-diarrheal drug treatments, their mechanisms of action, and their treatment results in a patient with severe bile acid diarrhea and intestinal failure

Drug	Mechanism of action	Treatment effect
Colestyramine (Questran®)	Bile salt sequestrant	Limited effect
Colesevelam (Cholestagel®)	Bile salt sequestrant	Limited effect
Pantoprazole	Proton pump inhibitor	No effect
Loperamide (Imodium®)	Decreases intestinal motility	No effect
Codeine phosphate	Decreases intestinal motility	No effect; sedation
Spironolactone	Increases renal potassium reabsorption	No effect on potassium deficiency
Octreotide	Antisecretory	No effect; abdominal pain
Liraglutide (Victoza®)	Increases glucagon-like peptide 1 (GLP-1)	No effect; weight loss of 2 kg to 52 kg
Obeticholic acid (Ocaliva®)	Stimulates ileal FGF19 production, thereby inhibiting hepatic bile acid production	Marked reduction of stool volume and fecal electrolyte loss

FGF19: Fibroblast growth factor 19.