cholestyramine / Generic mfg. - LARVOL DELTA

Lachnospiraceae-mediated bile acid metabolism promotes ileal epithelial regeneration following graft-versus-host disease damage (ASH 2025) - "Given that the number of ileal Paneth cells was significantlycorrelated with both GVHD clinical and histological scores of the ileum in this model, we utilized Panethcell numbers as a marker of impaired epithelial regeneration and GVHD severity.To investigate the impact of the ileal microbiota on ileal epithelial damage, we depleted the ilealmicrobiota using an antibiotic cocktail (ampicillin, enrofloxacin, metronidazole, and vancomycin) inallogeneic mice after SpTCD...was abrogated by cholestyramine, which binds andsequesters BAs broadly.The use of antibiotics is often necessary in allo-HSCT patients to treat bacterial infections...Preserving the abundance of Lachno spp. ortheir BA metabolic activity may represent a novel therapeutic strategy to enhance epithelial regenerationand reduce the severity of GVHD."

Bone Marrow Transplantation • Graft versus Host Disease • Immunology • Infectious Disease • THY1

Local interactions between innate immune signaling, microbiota, and bile acids drive the development of duodenal adenomas. (PubMed, Cell Mol Gastroenterol Hepatol) - "Bile acids and the microbiota are necessary for duodenal adenoma development and are potentially modifiable risk factors in humans at risk of duodenal adenomas. The recruitment of myeloid cells may promote tumor progression via the release of reactive oxygen species."

Journal • Oncology • Small Intestinal Carcinoma • CXCL1 • CXCR2 • MPO • S100A8 • TLR4

Efficacy of binders on sequestering per- and polyfluoroalkyl substances under in vitro ruminal conditions. (PubMed, J Dairy Sci) - "Binders, including bentonite, montmorillonite aluminum pillared clay, chitosan, activated charcoal Norit, and cholestyramine resin (CHM), were tested at a dose of 1.8% (wt/wt; fresh basis)...Molecular dynamics simulations showed that PFOS molecules were strongly encapsulated within the CHM polymeric structure, primarily driven by interactions between the positively charged CHM and the negatively charged PFOS and stabilized by the hydrophobic interactions between the backbone of PFOS and CHM. Findings highlight the potential application of CHM in reducing PFOS contamination in livestock."

Journal • Preclinical

Lipid-Lowering Therapy Is Underutilized Across LDL-C Levels in Autoimmune Disease Compared to Diabetes: A Nationwide Analysis (AHA 2025) - "Statins included atorvastatin, rosuvastatin, simvastatin, pravastatin, lovastatin, fluvastatin, pitavastatin. Non-statin therapies included icosapent ethyl, colesevelam, alirocumab, evolocumab, Bempedoic acid, cholestyramine, Inclisiran, colestipol, ezetimibe, gemfibrozil, omega-3 acid, fenofibrate...Non-statin lipid-lowering therapy use was significantly lower in autoimmune patients compared to those with diabetes across all LDL-C tertiles, with the largest differences observed at LDL <70 mg/dL (6.19% vs 10.24%, p<0.0001) and 70–99 mg/dL (4.05% vs 7.06%, p<0.0001).ConclusionDespite comparable ASCVD risk, patients with autoimmune disease are significantly less likely to receive statins or non-statin lipid-lowering therapy than those with DM across LDL-C levels. These findings show a need for improved cardiovascular prevention in this high-risk population."

Atherosclerosis • Cardiovascular • Diabetes • Dyslipidemia • Hepatology • Immunology • Inflammatory Arthritis • Lupus • Metabolic Disorders • Rheumatoid Arthritis • Rheumatology • Systemic Lupus Erythematosus

Bile Acid Binding Resins Improve Glucagon Receptor Agonist-Mediated Weight Loss in Diet-Induced Obese Mice. (PubMed, Obesity (Silver Spring)) - "Together, these studies suggest that BARs enhance the antiobesity effect of GCGR agonism in DIO mice, representing a novel antiobesity strategy."

Journal • Preclinical • Genetic Disorders • Obesity

Novel probiotic consortium sustains skeletal muscle function in hyperlipidemic rats. (PubMed, Biochem Biophys Res Commun) - "Male Wistar rats (300 ± 5 g) were randomised into 4 groups (n = 6) including control (7 % fat), hyperlipidaemia [(Hyp) 35 % fat], Hyp + Orlistat (10 mg/kg BW) + Cholestyramine (2g/100g of diet) (Hyp + O + C) and Hyp + Probiotics (Lactobacillus acidophilus, Bacillus coagulans, and Streptococcus thermophilus) (Hyp + Pr). Furthermore, the probiotics significantly (p < 0.05) upregulated the expression of SREBP-1c, PGC-1α, and UCP3 compared to the Hyp group. These findings suggest that a novel probiotic consortium sustains muscle function and integrity in hyperlipidemic rats."

Journal • Preclinical • Dyslipidemia • Muscular Atrophy • Obesity • FABP3 • FBXO32 • Myogenin

Incidence and Prevalence of Primary Biliary Cholangitis (PBC) and Cholestatic Pruritus (CP) in Germany: Results From a Statutory Health Insurance (SHI) Claims Analysis (ISPOR-EU 2025) - "Pruritus is a common symptom in PBC, especially in female patients. However, treatment patterns in Germany show decreasing reliance on cholestyramine, with increasing use of alternative therapies."

Reimbursement • US reimbursement • Dermatology • Hepatology • Immunology • Primary Biliary Cholangitis • Pruritus

The Use Of Beta-Alanine For The Management Of Aquagenic Pruritus (ACAAI 2025) - "Discussion Various treatments have been tried for Aquagenic Pruritus ranging from analgesics, transcutaneous electrical nerve stimulation, phototherapy, beta-blockers, cholestyramine, naltrexone, selective serotonin reuptake inhibitors, H1 and H2 antihistamines, baking soda, capsaicin, and baby oil as a barrier. As it is a rare condition and not well-studied, online aquagenic pruritus support group finds Beta-Alanine in the range of 750 mg to 2 grams before water contact to be highly effective for this condition. This was the only effective, therapeutic option for our patient."

Dermatology • Pruritus

The Hidden Villain: Chronic Diarrhea and Weight Loss Revealing Olmesartan Enteropathy (ACG 2025) - "Empiric trials of pancrelipase, cholestyramine, loperamide, and low-lactose diet failed to alleviate symptoms. Clinicians should maintain awareness of medication-induced enteropathies, particularly in elderly patients with unexplained malabsorptive symptoms and long-term ARB use. Abstract written with AI corrections.Figure: Villous atrophy seen during capsule endoscopy"

Cardiovascular • Celiac Disease • Gastrointestinal Disorder • Hypertension • Immunology • Infectious Disease • Novel Coronavirus Disease

Microscopic Colitis and Celiac Disease (ACG 2025) - "The patient was then trialed on cholestyramine with minimal symptom improvement before transitioning to vedolizumab. Given the generalized symptoms of microscopic colitis as well as benign appearing mucosa with endoscopic evaluation, diagnosing this disorder is often delayed. Our case emphasizes the need to check for microscopic colitis in cases of persistent symptoms of celiac disease despite strict dietary compliance."

Anemia • Celiac Disease • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology • ELANE

Diarrhea with Depression: Sertraline-Induced Microscopic Colitis (ACG 2025) - "2 months ago, she had switched from duloxetine to sertraline 100mg for uncontrolled mood symptoms without psychiatric consultation...Per guidelines, sertraline was held, and budesonide, loperamide, cholestyramine, and dicyclomine were started. Symptoms resolved at 4 weeks.Since sertraline is a commonly used and well-tolerated first-line agent for mood disorders, clinicians should suspect MC in patients with chronic diarrhea after starting it. Discontinuation and close follow-up to monitor for relapses are key to management.Figure: Colonoscopy"

Chronic Obstructive Pulmonary Disease • CNS Disorders • Colonic Polyps • Depression • Fatigue • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Mood Disorders • Peptic Ulcer • Psychiatry • Respiratory Diseases

Severe Colitis Mimicking Inflammatory Bowel Disease: A Rare Case of Cholestyramine-Related Granulomatous Injury (ACG 2025) - "Her symptoms persisted despite oral vancomycin, fidaxomicin, IV piperacillin-tazobactam, and IV steroids. Diagnosis may require confirmation by histology, especially when endoscopic findings are non-specific. Early suspicion can present unnecessary steroid and antibiotic use as well as surgical morbidity."

Clinical • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Inflammation • Inflammatory Bowel Disease

Sigmoid Ulceration With Cholestyramine Use: Medication-Associated Colitis? (ACG 2025) - "Given recent pembrolizumab therapy, his oncologist initiated a prednisone taper for presumed checkpoint inhibitor (CPI) colitis with initial improvement, but he experienced symptom relapse upon tapering.Repeat colonoscopy was performed to rule out CPI colitis. In this case, the temporal relationship between cholestyramine initiation and the development of ulceration, in conjunction with histologic evidence of cholestyramine crystals, supports a possible causative role. This case highlights the potential for BAS agents to cause clinically significant ulceration."

Anorexia • Fatigue • Gastroenterology • Gastrointestinal Disorder • Immunology • Solid Tumor • Urothelial Cancer

Acute Protoporphyric Hepatopathy as the Initial Presentation of Erythropoietic Protoporphyria in Adulthood (ACG 2025) - "Options include ursodeoxycholic acid, erythrocyte transfusions, plasmapheresis, cholestyramine, and bone marrow transplant. A - Canalicular and hepatocytic cholestasis with dense, brown-colored deposit in the canalicular hepatocytes, Kupffer cells, and portal macrophages. B – Polarized microscopy showing Maltese-Cross-positive material."

Clinical • Anemia • Bone Marrow Transplantation • Cholestasis • Genetic Disorders • Hematological Disorders • Hepatology • Inflammation • Liver Failure • Metabolic Disorders • Rare Diseases

BRIC or DILI: A Diagnostic Challenge (ACG 2025) - "He had a flu-like illness two weeks prior and began pantoprazole one month before symptoms...Cholestyramine provided partial symptom relief...Ursodiol was started, with subsequent improvement...Clinics in Liver Disease. 2003; 7(1):153–164"

Cholestasis • Cognitive Disorders • Dermatology • Genetic Disorders • Hepatology • Immunology • Infectious Disease • Liver Failure • Pruritus • ABCB1

Vagal Nerve Injury as a Complication of Transoral Incisionless Fundoplication (ACG 2025) - "He has reportedly tried antacids, PPIs, antibiotics, antiemetics, cholestyramine, loperamide and bulking agents without relief...He is currently taking pantoprazole 40mg daily. GERD remains a highly prevalent disease process in the United States...Considering the temporal relationship of this patient's symptoms and the TIF, a procedural complication must be considered including injury to the vagus nerve. Vagal nerve injury should be counseled as a potential side effect of TIF due to the significant impact it can have on patient's livelihood.Figure: Figure 1: A) Retroflexion during esophagogastroduodenoscopy demonstrating the prior transoral incisionless fundoplication B) The intact sutures of the prior transoral incisionless fundoplication"

Dermatology • Gastroenterology • Gastroesophageal Reflux Disease • Respiratory Diseases • ELANE • GAST

A Macroscopic Mystery: An Atypical Presentation of Microscopic Colitis (ACG 2025) - "Budesonide and cholestyramine offered limited relief.In the setting of persistent symptoms and fecal calprotectin elevation to 2410mcg/gm, vedolizumab was initiated...Despite use of vedolizumab, colestipol 4gm, budesonide 9mg, and anti-diarrheals, the patient remained symptomatic with multiple bowel movements per day.The patient was subsequently changed to infliximab...This case underscores the importance of recognizing atypical features of collagenous colitis and maintaining a high index of suspicion for overlapping or evolving diagnoses, particularly in those who fail conventional therapy. This case also elevates the discussion of microscopic colitis as part of a spectrum of chronic inflammatory bowel diseases.Figure: Index colonoscopy with mucosal inflammation and possible pseudomembranes"

Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • Mucositis

Zolbetuximab-Induced Colitis Leading to Colonic Perforation: A Call for Researching a Novel Drug (ACG 2025) - "The diarrheapersisted through scheduled Lomotil, Loperamide, and cholestyramine...Given the onset of symptoms shortly after initiation ofzolbetuximab without evidence of infection, this case represents zolbetuximab-induced colitiscomplicated with colonic perforation which is not a well-documented adverse reaction. This is apotentially serious complication to a novel agent which may require further evaluation in phase IVclinical trials and monitoring in clinical practice.Figure: There is discontinuity of the left lateral rectal wall with surrounding free airFigure: Flexible Sigmoidoscopy: Sigmoid Colon demonstrating localized inflammation"

Atrial Fibrillation • Dyslipidemia • Fatigue • Gastric Adenocarcinoma • Gastric Cancer • Gastroenterology • Gastroesophageal Junction Adenocarcinoma • Gastrointestinal Disorder • Hypertension • Hypertriglyceridemia • Immunology • Infectious Disease • Rheumatology • Solid Tumor • CLDN18

Refractory Collagenous Colitis Requiring Inpatient Infliximab Infusion (ACG 2025) - "Multiple therapies, including loperamide, diphenoxylate-atropine, budesonide, bismuth subsalicylate, cholestyramine, colesevelam, mesalamine, gluten-free diet, and recent initiation of prednisone with azathioprine for the current flare have been ineffective. Attempts to initiate outpatient biologic therapy, with infliximab or vedolizumab, were unsuccessful due to insurance denial...TPN was started and trials of octreotide and rifaximin yielded no improvement...Severity and chronicity of microscopic colitis may mimic that of inflammatory bowel disease, and biologic therapy such as TNF-α inhibitors may be used for treatment, although current knowledge is based on case reports and studies. Further research is needed to investigate the role, safety and efficacy of biologics for treating microscopic colitis, which may help streamline off-label treatments, decrease morbidity, improve barriers for initiating such medications and resource utilization."

Clinical • Cardiovascular • Celiac Disease • Gastroenterology • Gastrointestinal Disorder • Heart Failure • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Renal Disease

Prevalence of Overlooked Gastrointestinal Disorders in Patients Diagnosed With Irritable Bowel Syndrome: A Systematic Review of Misdiagnosis and Underlying Conditions (ACG 2025) - "Though these conditions mimic IBS, each requires distinct treatment - gluten-free diets for celiac, bile acid binders for BAD, budesonide for microscopic colitis, and antibiotics for SIBO...Identifying these conditions allows for targeted treatments - such as cholestyramine or a gluten-free diet - that can significantly relieve symptoms. Multiple studies have identified specific disorders in some IBS patients. This review includes 27 studies meeting our criteria. Around 3 - 4% of IBS cases may be undiagnosed celiac disease, and about 25% of IBS-D patients have unrecognized bile acid malabsorption."

Clinical • Review • Celiac Disease • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammatory Bowel Disease

Extraordinary Response to Odevixibat in an Adult Patient With Progressive Familial Intrahepatic Cholestasis Type 1 and Intractable Pruritus: A Case Report (ACG 2025) - "He had poor response to prior therapeutic measures including cholestyramine, ursodiol, sertraline, hydroxyzine, rifampin, and topical steroids. Hence, odevixibat should be considered as an option for refractory pruritus in adult patients with PFIC type 1.Figure: Table 1. Liver tests before (blue) and after (green) initiation of Bylvay (odevixibat)."

Case report • Clinical • Cholestasis • Dermatology • Fibrosis • Hepatology • Immunology • Liver Failure • Pruritus

Perplexing Severe Cholestasis in the Post-Partum Period (ACG 2025) - "Cephalexin-induced DILI was suspected...She did not tolerate cholestyramine and her jaundice and pruritus worsened. Ursodiol improved transaminases and ALP, but not bilirubin; it was discontinued due to diarrhea...Mild portal inflammation associated with ductular reaction (HE 400x)C. Periportal fibrosis with patchy perisinusoidal fibrosis on trichrome stain (trichrome 200x)"

Cholestasis • Dermatology • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Inflammation • Liver Failure • Pancreatitis • Primary Biliary Cholangitis • Pruritus

Autoimmune Collision: Severe Liver Injury in Thyroid Storm with Overlapping Grave's Disease and Autoimmune Hepatitis (ACG 2025) - "Given concern for thyroid storm the patient was treated with beta blocker, steroids, cholestyramine and methimazole. Differentiating drug-induced, thyrotoxic, and autoimmune liver injury remains a major challenge. Further research is needed to clarify mechanisms and optimize management."

Autoimmune Hepatitis • Cardiovascular • Endocrine Disorders • Grave’s Disease • Hepatology • Hypertension • Immunology • Infectious Disease • Inflammation • Liver Failure • Ophthalmology

Novel Use of Ileal Bile Acid Transport Inhibitor in Benign Recurrent Intrahepatic Cholestasis Refractory to Conventional Therapy (ACG 2025) - "Even though he responded well initially to pharmacotherapy including cholestyramine, ursodeoxycholic acid and rifampin, he subsequently required placement of nasobiliary drain during these episodes for symptom control...He was then treated off-label with IBAT inhibitor Odevixibat at a dose of 2400 mcg daily starting at onset of pruritic episodes with prompt and complete symptom relief and normalization of liver biochemical tests and serum bile acid levels...IBAT inhibitors are a novel class of drugs approved recently for the treatment of pruritus in patients 3 months of age and older with PFIC and Alagille's syndrome. Our case illustrates the potential role of IBAT inhibitors as a safe, effective and well-tolerated treatment option in aborting pruritic episodes in patients with BRIC unresponsive to conventional therapy, highlighting the potential applicability of this class of medications in a wider spectrum of genetic cholestatic disorders."

Cholestasis • Dermatology • Hepatology • Pruritus

Scratching the Surface: Successful Treatment of Severe Intrahepatic Cholestasis of Pregnancy With an Ileal Bile Acid Transporter Inhibitor (IBAT) (ACG 2025) - "Current standard of care include treatment with ursodeoxycholic acid (UDCA) which may be insufficient in severe cases...She was started on UDCA, cholestyramine and hydroxyzine...Despite maximal doses of UDCA, she continued to have worsening pruritus and rising BA with peak of 364 µmol/L in her third trimester.After discussion with maternal fetal medicine, she received Odevixibat though expanded access...While further study is needed, our case report demonstrated improvement in pruritus and serum BA in our patient with refractory ICP. This supports the need for potential for IBAT inhibitors as adjunctive therapy in select, high-risk ICP patient unresponsive to conventional therapy."

Cholestasis • Dermatology • Fibrosis • Gynecology • Hepatology • Immunology • Infectious Disease • Inflammation • Pruritus • ABCB1