Diagnosis and treatment of post-cholecystectomy diarrhoea

Association of cholecystectomy with short-term and long-term risks of depression and suicide

In addition to the known link between cholecystectomy and depression, the risk of developing short-term and long-term depression after surgery and whether such mental health issues leads to suicide were not known. Therefore, this study aimed to address these questions. Using data from the National Health Insurance Service of Korea (2002-2019), we conducted a retrospective cohort study including 6,688 cholecystectomy patients matched with 66,880 individuals without a history of cholecystectomy for suicide analysis and 6,694 cholecystectomy patients matched with 66,940 individuals for depression analysis. The non-cholecystectomy group was matched at a 1:10 ratio for sex and age. The incidence of depression and suicide were followed from the day of cholecystectomy to December 31, 2019. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards regression. Short-term depression risk within three years of cholecystectomy was significantly elevated (aHR 1.38, 95% CI 1.19-1.59), while the long-term depression risk beyond three years was not significantly greater (aHR 1.09, 95% CI 0.98-1.22). Cholecystectomy was not associated with an increased risk of suicide in any period. These findings highlight the importance of monitoring and providing postoperative mental health support for patients at risk of short-term depression after cholecystectomy. However, no association was observed with long-term depression or suicide risk.

The causal relationship between cholecystectomy and IBD/IBS and the role of bile acids and gut microbiota: a two-sample Mendelian randomization study

OBJECTIVE

This study aims to explore the causal relationship between cholecystectomy and inflammatory bowel disease (IBD)/irritable bowel syndrome (IBS) and the role of serum bile acids and gut microbiota in this context.

METHODS

Utilizing genetic variant data from previous Genome-Wide Association Studies (GWAS), this study employed a two-sample MR approach to assess the causal effect of cholecystectomy on IBD/IBS.

RESULTS

The MR analysis suggested a potential negative causal relationship between cholecystectomy and UC (p = 0.0233, OR 0.9773, 95%CI 0.9581-0.9969) and a positive causal relationship between cholecystectomy and IBS (p = 0.0395, OR 4.077, 95%CI 1.0699-15.5362). Various sensitivity analyses reinforced the reliability of the causal relationship. However, the analysis did not find definitive results between serum bile acids or gut microbiota and cholecystectomy or IBD/IBS, possibly due to insufficient statistical power. MVMR find a causal relationship between bile acids and IBS (p = 0.0015, b = 0.4085) and UC (p = 0.0198, b = 0.0029).

CONCLUSION

This study provides evidence of a causal relationship between cholecystectomy and IBD/IBS, highlighting the potential risk reduction for UC and increased risk for IBS following cholecystectomy. The role of bile acids and gut microbiota in this relationship remains unclear, necessitating further research to validate the causality and explore underlying mechanisms.

Prevalence and determinants of postprandial diarrhea in a tertiary care center

BACKGROUND AND AIMS

Postprandial diarrhea (PPD) is commonly seen in patients with disorders of gut-brain interaction (DGBI), but the factors associated with it have not been well studied. In this study, we aim to study the burden, impact, and predictors of PPD using a clinical cohort of DGBI patients.

METHODS

This study included patients with chronic diarrhea fulfilling ROME IV criteria for irritable bowel syndrome (IBS) or functional diarrhea (FDiarr). PPD was defined as patients reporting mushy/watery stools following meals ≥30% of the time in the last 3 months using a ROME IV question on PPD. Age, sex, and BMI, the severity of diarrhea, abdominal pain, depression, anxiety, somatization, and quality of life were assessed using validated measures. Person's chi-square test and Student's t-test were used to compare variables. A multiple linear regression model with backward elimination was done to determine predictors of PPD severity.

KEY RESULTS

Of 213 eligible patients, more than three-fourth of patients (75.6%) had PPD. Women (79.0%, p = 0.037), patients with ROME IV diagnosis of IBS-D (90.5%, p = 0.002), and functional dyspepsia (83.2%, p = 0.014), and those with a history of cholecystectomy (CCY) (95.5%, p = 0.022) were more likely to report PPD. PPD patients experienced more severe abdominal pain, diarrhea, and decreased quality of life (QoL) but showed no significant difference in BMI, anxiety, depression, sleep, or somatization. In our regression model, female sex and history of CCY were independent predictors of PPD.

CONCLUSIONS AND INFERENCES

PPD is frequently reported among chronic diarrhea patients and is associated with more severe GI symptoms and decreased QoL. Female sex and CCY predict PPD, while psychological factors do not.