Bowel habits and bile acid malabsorption in the months after cholecystectomy

Bile acid malabsorption has been supposed to play a major pathogenetic role in postcholecystectomy diarrhea. Therefore, the aim of this study was to define the effect of cholecystectomy (CHE) on bowel habits and bile acid absorption.

Fifty-one patients were prospectively studied before, at 4 wk, and 12 wk after elective CHE for changes of bowel habits, occurrence of diarrhea, and signs of bile acid malabsorption. Bowel habits were assessed by interview. Serum concentrations of 7alpha-hydroxy-4-cholesten-3-one were used as a marker of bile acid malabsorption. Statistics were performed with the McNemar chi2 test for discrete values and Student's paired t test for continuous values.

After CHE, there was an increase of patients reporting more than one bowel movement per day (from 22% before CHE to 51% [p < 0.001] and 45% [p < 0.005] at 1 month and 3 months after CHE, respectively) and of patients reporting loose stools (from 2% to 47% [p < 0.001] and 33% [p < 0.001], respectively). Three months after CHE, three patients (6%) reported intermittent diarrhea. Serum levels of 7alpha-hydroxy-4-cholesten-3-one increased from 25.4+/-14.5 ng/ml to 46.5+/-29.5 ng/ml (p < 0.001) and 52.5+/-33.0 ng/ml (p < 0.001), respectively. Unexpectedly, changes of 7alpha-hydroxy-4-cholesten-3-one in serum were unrelated to changes of bowel habits.

CHE results in considerable changes of bowel habits and an increased loss of bile acids from the intestine in some patients. Bile acid malabsorption, however, may not explain changes of bowel habits after CHE.