Bile acids and post-vagotomy diarrhoea

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Abstract
Cholecystectomy increases the risk of post-vagotomy diarrhoea and bile acid binding agents may relieve it, suggesting a role for bile acids in its pathogenesis. The faecal bile acid loss in 15 patients with episodic diarrhoea after vagotomy and drainage was not raised when compared with 12 normal subjects, except on days when diarrhoea occurred. This elevation was caused by an increase in stool weight rather than bile acid concentration, suggesting that the increased bile acid loss during attacks was not causally related. Asymptomatic vagotomy patients excreted normal amounts of bile acids. Seven patients with episodic diarrhoea after vagotomy and drainage with cholecystectomy continuously excreted excessive amounts of bile acids when compared with normal subjects and asymptomatic patients. The concentration of bile acid in their stools was higher than that observed in symptomatic patients after vagotomy and drainage alone. The continuous presence of excess bile acid may prime the colon to react more readily to stimuli caused by disturbed gastric emptying and rapid small bowel transit, without being the main factor in causing the condition. These findings may explain the increased risk of diarrhoea when cholecystectomy is combined with vagotomy.