From the Guidelines
Gallbladder removal can lead to bile acid diarrhea, which affects a significant portion of patients, with studies suggesting that up to 94% of patients may experience recurrent diarrhea when treatment is withdrawn 1. The effects of gallbladder removal on stool are primarily related to the disruption of bile storage and release, leading to continuous bile flow into the small intestine. This can cause loose, watery stools, more frequent bowel movements, and other symptoms such as urgency and increased gas.
- Key symptoms of postcholecystectomy diarrhea include:
- Loose, watery stools
- More frequent bowel movements
- Urgency
- Increased gas
- Lighter-colored stools According to a study published in Clinical Gastroenterology and Hepatology, cholestyramine (2‒12 g/d for 1‒6 mo) was effective in managing bile acid diarrhea in 23 of 26 patients, with 61% of patients able to control their symptoms with on-demand therapy 1.
- Management options for postcholecystectomy diarrhea include:
- Dietary modifications (e.g., smaller, more frequent meals, reduced fat intake, increased fiber consumption)
- Over-the-counter medications (e.g., loperamide, cholestyramine)
- Medical evaluation if symptoms persist or are severe It is essential to note that while some patients may experience improvement in symptoms over time, others may require ongoing management to control their symptoms, as evidenced by the high rate of recurrent diarrhea when treatment is withdrawn 1.
From the Research
Effects of Gallbladder Removal on Stool
The removal of the gallbladder, also known as cholecystectomy, can have several effects on stool. Some of the key effects include:
- Diarrhea: Studies have shown that diarrhea can develop in some patients after cholecystectomy 2, 3, 4.
- Bile acid malabsorption: Bile acid malabsorption has been suggested to play a major role in postcholecystectomy diarrhea 3, 4.
- Changes in bowel habits: Cholecystectomy can result in changes to bowel habits, including an increase in the number of bowel movements per day and loose stools 3.
- Increased loss of bile acids: The removal of the gallbladder can lead to an increased loss of bile acids from the intestine 3.
Mechanisms and Responses
The mechanisms behind these effects are not fully understood, but research suggests that:
- Bile acid diarrhea may occur due to disruption of the enterohepatic circulation after cholecystectomy 4, 5.
- FGF19 within the gallbladder may not be directly associated with the development of bile acid diarrhea 5.
- Cholestyramine therapy can be effective in treating bile acid diarrhea in patients with previous cholecystectomy 2, 4, 6.
- Gallbladder PPARα may have a significant correlation with stool consistency, with lower PPARα concentrations associated with looser stools 5.
Prevalence and Response to Treatment
Studies have reported that:
- Approximately 70% of patients with chronic watery diarrhea and previous cholecystectomy have bile acid diarrhea 4.
- The response rate to colestyramine in patients with bile acid diarrhea is around 79% 4.
- Cholecystectomy can result in significant changes to bowel habits and an increased loss of bile acids from the intestine 3.