Bile acid, gallbladder and enterohepatic dysfunction patterns
For cases where fat handling, post-cholecystectomy change, bile-acid diarrhoea questions, or sequestrant responses sit at the centre of the record.
This page is for people whose record points toward bile: a gallbladder removed years before the illness settled in, loose stools that answer partially to a sequestrant, fat malabsorption, oxalate concerns, or specialty results reporting shifted primary and secondary bile acids. Bile chemistry is one of the few places where the microbiome and host metabolism are chemically inseparable, which makes it a useful — and frequently over-read — place to reason about.
What records in this area tend to contain
These are descriptions of records, not diagnostic criteria. Recognising several of them does not mean you have a condition, and none of them is being asserted about you.
- Cholecystectomy, biliary dyskinesia, or gallstone history preceding the chronic phase
- Loose, urgent, or pale stools with a fat-related pattern
- Partial or ambiguous response to a bile-acid sequestrant
- Specialty stool panels reporting altered primary-to-secondary bile acid ratios
- Fat-soluble nutrient findings, or oxalate-related concerns raised elsewhere
- Right-upper-quadrant discomfort with unremarkable imaging
The analytical work on a case like this
- Chronology of biliary events, surgery, and the onset of the current pattern
- Microbial bile-acid transformation considerations, including where the evidence is strong and where it is not
- Enterohepatic recirculation and ileal reabsorption questions the record can and cannot answer
- FXR and TGR5 signalling as candidate mechanisms, stated as hypotheses rather than findings
- Interaction with motility, barrier function, and fat-dependent nutrient status
- Whether sequestrant or enzyme trials in the record behaved as the leading hypothesis predicts
What the work is trying to answer
These are the questions the reconstruction is built around. They are questions, not promises — some records answer them clearly and some do not, and the written synthesis says which.
- Does the record support a bile-acid-driven reading, or is bile a downstream consequence of something else?
- Which findings would be expected if malabsorption were primary, and are they present?
- Has anything in the workup actually tested bile handling, or has it been inferred?
- What would a clinician need to order to settle the question rather than extend it?
What would argue against the leading reading
Every synthesis states the alternatives it could not exclude. For this area, the most important ones are:
- Pancreatic exocrine insufficiency producing a similar fat-handling picture
- Carbohydrate malabsorption or an osmotic pattern misattributed to bile
- Microscopic colitis or another mucosal process
- Rapid transit from a motility or medication cause, with bile as a passenger finding
- Panel-derived bile acid metrics with limited analytical validation for individual decision-making
Mechanistic reading of bile-related findings in a record. Not a diagnosis of bile acid malabsorption or any biliary disease, not a recommendation to start, stop, or change a sequestrant, enzyme, or any medication, and not a substitute for gastroenterology or surgical assessment.
Mohammed Attallah is the founder of BiomeLogic and developed the Host Capacity Model independently; it is a working framework, not medical consensus or a clinically validated instrument. He is not a licensed clinician. Every output is educational analysis prepared for review, modification, or rejection by your own medical team. Full scope statement →
The service is chosen by scope, not by condition
There is no separate price for any pattern on this page. Gate 1 is free, takes a few minutes, needs no files, and ends with a written reply about whether the analysis suits your case and which engagement would fit.
Comprehensive Systems-Biology Case Analysis
$995The whole case: full-record reconstruction, a live working session, and a written synthesis with an intervention discussion framework.
Read the full scope →Lab Pattern & Results Review
$500A defined set of results you already hold, where chronology and multisystem history do not materially change the reading.
Read the full scope →Complex Case Deep Dive
$1,500Unusually extensive or internally contradictory records needing expanded chronology and cross-test reconciliation. Scope, not a better method.
Read the full scope →
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