Abstract
Background and Aims: People with bile acid malabsorption/diarrhea and concurrent hypercholesterolaemia struggle to tolerate statins (HMG-CoA reductase inhibitors) and fibrates because these pharmacological agents can worsen their symptoms. Statins increase bile acid production by promoting expression of cholesterol 7α hydroxylase (CYP7A1), the rate-limiting enzyme in synthesis of bile acids from cholesterol. Fibrates increase bile acid transport from hepatocytes by inducing expression of BA efflux transporters and decrease expression of ileal BA transporters reducing uptake.
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