From the Guidelines
Gastrointestinal upset after gallbladder removal is typically managed with dietary modifications, over-the-counter medications, and in some cases, prescription bile acid sequestrants. To manage these symptoms, start by modifying your diet to include smaller, more frequent meals that are low in fat, as this can help reduce the strain on the digestive system 1. Gradually reintroduce fats to determine your tolerance level. Over-the-counter medications like simethicone (Gas-X) can help with gas and bloating, while loperamide (Imodium) may control diarrhea when needed.
Causes of GI Upset
Some key causes of GI upset after gallbladder removal include:
- Increased gut transit
- Bile acid malabsorption
- Increased entero-hepatic cycling of bile acids, as noted in the guidelines for the investigation of chronic diarrhoea 1
Treatment Options
For persistent symptoms, your doctor might prescribe bile acid sequestrants such as cholestyramine (Questran) or colestipol (Colestid) at starting doses of 4g once or twice daily, which bind excess bile acids that can cause diarrhea 1. Digestive enzymes with meals may also improve digestion.
Outcome and Follow-Up
These symptoms occur because without a gallbladder to store and regulate bile release, bile flows continuously into your intestines, potentially causing irritation and faster digestion. Most people adapt within 2-3 months as the body adjusts to this new digestive pattern, but consult your doctor if symptoms are severe or persistent, as they could indicate other digestive issues requiring different treatment 1.
From the Research
GI Upset after Gallbladder Removal
- GI upset after gallbladder removal is a common issue, with up to 10% of individuals developing postcholecystectomy syndrome (PCS) 2.
- PCS can be caused by various factors, including extra-biliary conditions that may have existed before the operation, and can manifest as higher digestive problems 2.
- Bile microlithiasis has been identified as a cause of postcholecystectomy pain, and treatment with ursodeoxycholic acid (urso) has been shown to improve or resolve symptoms in patients with bile crystals 3.
- Ursodeoxycholic acid has also been used to treat non-extractable common bile duct stones, with a high success rate of stone clearance 4.
- In addition to its use in treating PCS, ursodeoxycholic acid has been shown to prevent gallstone formation and subsequent cholecystectomy after bariatric surgery 5.
Symptoms and Treatment
- Symptoms of GI upset after gallbladder removal can include right upper-quadrant abdominal pain, and may be similar to those experienced before the operation 2, 3.
- Treatment options for PCS are varied, and may include endoscopy, ursodeoxycholic acid, and other therapies 2, 3, 4.
- The effectiveness of treatment for PCS can depend on the underlying cause of the condition, and may require a combination of therapies 2, 3, 4.