Rates of Bile Acid Diarrhoea After Cholecystectomy: A Multicentre Audit

Abstract

Introduction Bile acid diarrhoea (BAD) can occur due to disruption to the enterohepatic circulation, e.g. following cholecystectomy. Post-cholecystectomy diarrhoea has been reported in 2.1–57.2% of patients; however, this is not necessarily due to BAD. The aim of this study was to determine the rates of bile acid diarrhoea diagnosis after cholecystectomy and to consider investigation practices. Methods A retrospective analysis of electronic databases from five large centres detailing patients who underwent laparoscopic cholecystectomy between 2013 and 2017 was cross-referenced with a list of patients who underwent 75SeHCAT testing. A 7-day retention time of <15% was deemed to be positive. Patient demographics and time from surgery to investigation were collected and compared for significance (p < 0.05). Results A total of 9439 patients underwent a laparoscopic cholecystectomy between 1 January 2013 and 31 December 2017 in the five centres. In total, 202 patients (2.1%) underwent investigation for diarrhoea via 75SeHCAT, of which 64 patients (31.6%) had a 75SeHCAT test result of >15%, while 62.8% of those investigated were diagnosed with bile acid diarrhoea (BAD). In total, 133 (65.8%) patients also underwent endoscopy and 74 (36.6%) patients had a CT scan. Median time from surgery to 75SeHCAT test was 672 days (SD ± 482 days). Discussion/Conclusion Only a small proportion of patients, post-cholecystectomy, were investigated for diarrhoea with significant time delay to diagnosis. The true prevalence of BAD after cholecystectomy may be much higher, and clinicians need to have an increased awareness of this condition due to its amenability to treatment. 75SeHCAT is a useful tool for diagnosis of bile acid diarrhoea.

Disordered Gut Microbiota Correlates With Altered Fecal Bile Acid Metabolism and Post-cholecystectomy Diarrhea

“…With high incidence, PCD affects a huge amount of outpatients' quality of life by a large margin for the postoperative alterations in bowel habits (Ruiz-Campos et al, 2019;Ahmad and Faulx, 2020). BAD is accepted as a common cause for PCD according to the results of SeHCAT test (Farrugia et al, 2021). In this article, we deciphered metabolic characteristics of fecal bile acid metabolism among three groups, and found excessive fecal excretion in diarrheal patients.…”

“…It has been considered as a safe surgical approach for a long time and accumulating advances in minimally invasive surgery promote its clinical application (Baron et al, 2015). However, increased risks of many complications in patients who underwent cholecystectomy are obtaining growing attention (Ioannou, 2010;Chen et al, 2014), among which post-cholecystectomy diarrhea (PCD) highly occurred (Fort et al, 1996;Damsgaard et al, 2018;Farrugia et al, 2021). Postoperative diarrhea, characterized by persistent altered bowel habits including chronic diarrhea, defecation urgency, and increased defecation frequency, reduces the quality of life greatly in a huge number of outpatients (Lamberts et al, 2012).…”

“…Postoperative diarrhea, characterized by persistent altered bowel habits including chronic diarrhea, defecation urgency, and increased defecation frequency, reduces the quality of life greatly in a huge number of outpatients (Lamberts et al, 2012). Recently, the incidence of PCD has been reported to increase from 2.1 to 57.2%; however, the mechanisms responsible for the persistence of PCD are still unknown (Fort et al, 1996;Damsgaard et al, 2018;Farrugia et al, 2021).…”

Fisiopatologia e tratamento para a Diarreia Pós-Colecistectomia: uma revisão de literatura / Pathophysiology and treatment for Postcholecystectomy Diarrhea: a review of the literature

“…A colecistectomia é um procedimento cirúrgico comum que consiste na remoção da vesícula biliar, sendo realizado como forma de tratamento para doenças biliares em pacientes sintomáticos. Assim, em 2014, foram realizadas 130 mil colecistectomias no Brasil, por meio do Sistema Único de Saúde (DEL GRANDE et al, 2017;FARRUGIA et al, 2021). Nesse contexto, a Síndrome Pós-Colecistectomia (SPC), descrita pela primeira vez em 1947 por Womack e Crider, refere-se à persistência ou ao aparecimento de sintomas gastrointestinais após a realização da colecistectomia, podendo estar presentes em 5 à 47% dos pacientes colecistectomizados.…”

Esófago hipercontráctil, activación inmunitaria sistémica en dispepsia funcional, malabsorción de ácidos biliares en diarreas funcionales y tratamiento del estreñimiento en pediatría

“…La MAAB es un aspecto fisiopatológico que ha cobrado importancia en los últimos años para explicar un subgrupo de pacientes con diarrea funcional y SII-D, ya que aproximadamente el 30% de estos últimos la presentan; y si bien solo un 6% aproximadamente de los pacientes colecistectomizados también desarrollan diarrea por MAAB, es un aspecto que tener en cuenta como diagnóstico diferencial en pacientes que consulten por diarrea [14][15][16] , considerando que los AB tienen un efecto estimulante de la motilidad colónica 17 . No obstante, un estudio más reciente demostró que más del 62% de los pacientes colecistectomizados tenía MAAB 18 . Estas diferencias epidemiológicas requieren ser confirmadas.…”