Can gallstones cause diarrhea, especially after consuming fatty foods?

Gallstones Do NOT Cause Diarrhea After Fatty Foods

According to the American College of Physicians guidelines, belching, bloating, intolerance of fatty foods, and chronic pain are problems NOT attributable to gallstone disease. 1

What Gallstones Actually Cause

The typical symptomatic manifestation of gallstones is episodic biliary colic, characterized by:

• Severe, steady pain in the epigastrium and/or right upper quadrant that is unaffected by household remedies, position change, or gas passage 1
• Sudden onset that often awakens patients from sleep, lasting hours to up to a day 2
• May radiate to the upper back and be associated with nausea 2

Gallstone disease is specifically NOT indicated by pain that frequently comes and goes or lasts less than 15 minutes 1

True Complications of Gallstones

The actual complications attributable to gallstone disease include:

• Acute cholecystitis 1
• Acute pancreatitis 1
• Common duct obstruction 1
• Ascending cholangitis 1
• Gallbladder cancer 1
• Gallstone ileus 1

What CAN Cause Diarrhea After Fatty Foods

Post-Cholecystectomy Diarrhea

Chronic diarrhea may occur in up to 10% of patients AFTER cholecystectomy (gallbladder removal surgery), not from the gallstones themselves. 1 This occurs through mechanisms including:

• Increased gut transit 1
• Bile acid malabsorption 1, 3, 4
• Increased enterohepatic cycling of bile acids 1

Bile Acid Malabsorption

If diarrhea after fatty foods is present, consider bile acid malabsorption, which:

• Typically presents with chronic watery diarrhea, often worse after meals 3, 4
• Can occur after ileal resection or in post-cholecystectomy patients 4
• Is treated with bile acid sequestrants like cholestyramine as first-line therapy 3, 4

Clinical Pitfall to Avoid

Do not attribute dyspeptic symptoms (bloating, fatty food intolerance, chronic discomfort) to gallstones themselves. 1 These symptoms are common in persons with gallstones but are probably unrelated to the stones and frequently persist after cholecystectomy. 2 This misattribution can lead to unnecessary surgery that will not resolve the patient's gastrointestinal complaints.

When to Consider Cholecystectomy

Surgery is indicated for:

• Symptomatic gallstones with typical biliary colic 1
• Acute cholecystitis (early cholecystectomy within 24 hours) 5
• Other gallstone-related complications 1

NOT for vague dyspeptic symptoms or fatty food intolerance alone. 1