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I am almost 2 years post bilateral mastectomy. Been on Anastrozole and now Exemestane for 9 mths. I had my gallbladder removed 8 years ago.
Answer Summary
Members explored the question of whether Aromatase Inhibitors (AIs) like Exemestane can trigger Bile Acid Malabsorption or related gut issues,... Read more
@DianeN I also had gall bladder removed. Since used Rx Colestipol to absorb any bile. On all 3 AIs had alternating diarrhea/constipation...Colestipol or Miralax days.
I appreciate your blood work comments. I will check mine. Always wondered why % was high when count normal.
Also, think Sue has a point about Estrogen.
Keep us informed.
@A MyBCTeam Member
I am so glad that you are researching this.
It is the rare issues with Aromatase Inhibitors that we have to discover ourselves.
You are going through a lot if you have colitis symptoms.
Arm yourself with documents where you discovered this information and take someone with you to this appointment if the Dr. wants to see you in person.
Check rare side effects on Pub Med and Mayo Clinic Contact and all the major BC teaching hospitals and BC sites.
Go to drugs.com
Please keep us posted.
We all have to be our own advocates.
It takes a lot of inner strength to step up to the plate and figure out what is wrong and make change.
I’m starting to think it isn’t Bile Acid Malabsorption and could be this:
Exemestane-induced eosinophilic colitis is a rare drug reaction where aromatase inhibitors cause an accumulation of eosinophils in the colon. A normal total WBC count alongside a high absolute eosinophil count.
My WBC was normal but eosinophils were extremely elevated on my last bloodwork. I’m getting it rechecked in a couple of weeks.
@A MyBCTeam Member
Google search:
“While there is no direct evidence that Aromatase Inhibitors (AIs) (e.g., anastrozole, letrozole) cause Bile Acid Malabsorption (BAM), the two can intersect significantly in cancer care.
AIs commonly cause gastrointestinal side effects like diarrhea, which can mimic or worsen the symptoms of pre-existing BAM.
How Aromatase Inhibitors Affect the GutAIs lower estrogen levels, which can lead to changes in gut motility, mucosal health, and the microbiome, sometimes exacerbating chronic diarrhea.
Because BAM occurs when the small intestine cannot properly reabsorb bile acids (often caused by prior radiation, bowel surgery, or inflammatory bowel disease), any additional digestive stress from AIs can make BAM symptoms feel much more severe.
Management and ConsiderationsIf you are taking an AI and experiencing severe, persistent diarrhea, it is essential to explore both BAM and AI-specific side effects with your medical team:
Testing: A specialist (gastroenterologist) can test for BAM using a non-invasive SeHCAT scan or a serum C4 test.Bile Acid
Sequestrants: If BAM is diagnosed, the standard treatment is a bile acid sequestrant (like cholestyramine) to bind the excess bile acids.
Vitamin Deficiencies: Long-term BAM and the use of sequestrants can decrease the absorption of fat-soluble vitamins (A, D, E, K). Your doctor may need to monitor or supplement these, especially since AIs can already impact bone density.
Medication Review: Aromatase inhibitors are processed by the liver and biliary tract, so any treatment or dietary changes for BAM should be reviewed to prevent drug interactions or further liver strain.“
@A MyBCTeam Member and Sue10
Thanks for for sharing this informative and interesting information.
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