What are the stool changes associated with gallbladder (biliary) disease?

From the Guidelines

Gallbladder disease is associated with noticeable changes in stool appearance, particularly pale, clay-colored, or light-colored stools, due to insufficient bile reaching the intestines, as well as greasy, floating stools and diarrhea resulting from poor fat digestion. These stool changes occur because bile, stored in the gallbladder, gives stool its normal brown color, and when gallstones block the bile ducts or inflammation affects gallbladder function, bile cannot reach the intestines, leading to lighter-colored stools 1. Patients may also experience steatorrhea, a condition characterized by excessive fat in the stool, due to poor fat digestion, as bile is essential for fat absorption. Diarrhea can occur when undigested fat irritates the colon. Some patients might notice darker urine alongside these stool changes as bilirubin, normally excreted in bile, gets redirected into the bloodstream and filtered by the kidneys.

Key Stool Changes Associated with Gallbladder Disease

• Pale, clay-colored, or light-colored stools
• Greasy, floating stools (steatorrhea)
• Diarrhea
• Darker urine due to increased bilirubin levels

These stool changes often appear alongside other gallbladder symptoms like right upper quadrant pain, nausea, bloating, and intolerance to fatty foods. If you experience these stool changes, especially with accompanying symptoms, seek medical attention promptly as they may indicate gallstones, cholecystitis, or bile duct obstruction requiring treatment ranging from dietary modifications to medications like ursodeoxycholic acid or surgical interventions such as cholecystectomy 1. The most recent and highest quality study, published in 2017, provides updated guidance on the management of common bile duct stones, emphasizing the importance of prompt diagnosis and treatment to prevent complications 1.

From the FDA Drug Label

The sites of the drug’s therapeutic actions are in the liver, bile, and gut lumen. Free ursodiol, 7-keto-lithocholic acid, and lithocholic acid are relatively insoluble in aqueous media and larger proportions of these compounds are lost from the distal gut into the feces. Eighty percent of lithocholic acid formed in the small bowel is excreted in the feces, but the 20% that is absorbed is sulfated at the 3-hydroxyl group in the liver to relatively insoluble lithocholyl conjugates which are excreted into bile and lost in feces.

The stool changes associated with gallbladder (biliary) disease are not directly addressed in the provided drug label. However, it can be inferred that lithocholic acid, a byproduct of ursodiol metabolism, is excreted in the feces.

• 80% of lithocholic acid is excreted in the feces.
• The remaining 20% is absorbed, conjugated, and then excreted into bile and lost in feces. However, the label does not provide information on how gallbladder disease affects stool. 2

From the Research

Stool Changes Associated with Gallbladder (Biliary) Disease

There are no direct research papers provided to assist in answering this question regarding stool changes associated with gallbladder (biliary) disease. The studies provided focus on the management and outcomes of gallbladder and common bile duct stones 3, 4, gastroduodenal pathology in patients with asymptomatic gallbladder stones 5, risk factors for cholelithiasis 6, and epidemiological trends of gallbladder and biliary diseases 7.

Key Findings from Provided Studies

• A "laparoscopy-first" approach for patients with gallbladder and common bile duct stones is safe and feasible, potentially reducing the need for difficult surgical procedures and unnecessary ERCPs 3.
• Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and stent placement is an effective treatment for bile leaks after cholecystectomy, including those from the duct of Luschka 4.
• Patients with asymptomatic gallbladder stones may have underlying gastroduodenal pathologies, such as peptic ulcers and gastritis, which should be considered to avoid unnecessary cholecystectomies 5.
• Understanding risk factors for cholelithiasis is crucial for developing preventive measures and educating patients 6.
• Globally, the incidence, mortality, and disability-adjusted life years (DALYs) due to gallbladder and biliary diseases have increased, but age-standardized rates show a downward trend 7.

Implications for Gallbladder and Biliary Diseases

• The management of gallbladder and common bile duct stones requires careful consideration of the approach to minimize complications and improve outcomes 3, 4.
• Asymptomatic gallbladder stones may be associated with other gastrointestinal pathologies, emphasizing the need for thorough evaluation before surgical intervention 5.
• Identifying and addressing risk factors for cholelithiasis could help in reducing the burden of gallbladder disease 6.
• The global trend of decreasing age-standardized rates for gallbladder and biliary diseases suggests the potential effectiveness of current interventions and the need for continued public health efforts 7.