Value of bile-acid binding agents in post-vagotomy diarrhoea

Cholecystectomy increases the incidence of post-vagotomy diarrhoea. The effect of agents which either bind bile acids or prevent their action on the colonic mucosa has been studied in 31 patients with post-vagotomy diarrhoea--15 had had vagotomy and pyloroplasty alone and 16 vagotomy and pyloroplasty and cholecystectomy. Cholestyramine was particularly useful after the combined operation. Aluminium hydroxide in large doses has a similar mechanism of action to cholestyramine and is cheaper and more palatable, but propranolol was of no value. This study suggests that the excretion and chemical composition of bile and the handling of bile acids by the small intestine is of fundamental importance in the pathogenesis of post-vagotomy diarrhoea.