Diarrhea after cholecystectomy

Article by Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital

Cholecystectomy can change the flow of bile to the intestines. The occurrence of diarrhea after cholecystectomy may be related to changes in the gut microbiota. However, little is known about the relationship between gut microbiota and diarrhea following cholecystectomy.

Diarrhea is part of the post-cholecystectomy syndrome, which is difficult to treat. After cholecystectomy, bile enters the duodenum directly, independent of the timing of meals. The interaction between bile acids and gut bacteria is altered. The occurrence of diarrhea after cholecystectomy may be related to alterations in the gut microbiota. However, little is known about the relationship between gut microbiota and diarrhea following cholecystectomy.

Approximately 12% - 35.6% of patients after cholecystectomy have chronic diarrhea of ​​varying degrees. High-throughput sequencing of the 16S rRNA gene was used to characterize the composition and diversity of the complex gut microbiota community in patients with post-cholecystectomy diarrhea. The results indicate that the decrease in the diversity and abundance of the intestinal microbiota after cholecystectomy can cause diarrhea. These findings demonstrate an association between post-cholecystectomy diarrhea and gut microbiota, particularly with regard to Prevotella and Bifidobacterium.

Cholecystectomy can change the flow of bile to the intestines. There are billions of bacteria in the human intestinal tract, which can be divided into 3 types according to their function: beneficial bacteria, harmful bacteria and neutral bacteria. After cholecystectomy, bile enters the duodenum directly, independent of the timing of meals. The bile acid metabolic balance is disrupted and primary bile acid production is increased. Interactions between bile acids and gut bacteria are altered. The occurrence of diarrhea after cholecystectomy may be related to changes in bile flow into the intestine following cholecystectomy.
Several studies have provided evidence that, after surgical removal of the facial pouch, the gut microbiota maintains normal digestive function. However, changes in the microbial community contributed to gastrointestinal symptoms. Thus, it can be seen that the gut microbiota plays an important role in the development of several disease states, such as: immune, metabolic and even skin diseases.
Cholecystectomy has become the most common biliary tract surgery. However, diarrhea complications after cholecystectomy were largely ignored, greatly affecting the patient's quality of life.

References:
Li YD, Liu BN, Zhao SH, Zhou YL, Bai L, Liu EQ. Changes in gut microbiota composition and diversity associated with post-cholecystectomy diarrhea. World J Gastroenterol 2021; 27(5): 391-403 [PMID: 33584071 DOI: 10.3748/wjg.v27.i5.391]