The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Association between dietary intake and postlaparoscopic cholecystectomic symptoms in patients with gallbladder disease

  • Shin, Yongju (Department of Food and Nutrition, Hanyang University College of Human Ecology) ;
  • Choi, Dongho (Department of Surgery, Hanyang University College of Medicine) ;
  • Lee, Kyeong Geun (Department of Surgery, Hanyang University College of Medicine) ;
  • Choi, Ho Soon (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Park, Yongsoon (Department of Internal Medicine, Hanyang University College of Medicine)
  • Received : 2016.07.12
  • Accepted : 2016.10.10
  • Published : 2018.07.01
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Abstract

Background/Aims: After cholecystectomy, patients have reported postcholecystectomic syndromes such as abdominal symptoms, dyspepsia, and diarrhea, which suggest a relationship between cholecystectomic symptoms and diet, although the details of this association remain unclear. The present study investigated the hypothesis that dietary intake of nutrients and foods was significantly associated with postcholecystectomic syndromes. Methods: Gallstone patients (n = 59) who underwent laparoscopic cholecystectomy were enrolled, and dietary intake and clinical parameters were assessed immediately postcholecystectomy and 3 months later. Results: There were no significant differences in biochemical measurements or characteristics between symptomatic and asymptomatic patients. Immediately postcholecystectomy, there were no significant differences in consumption of nutrients or foods between symptomatic and asymptomatic patients. However, 3 months after cholecystectomy, symptomatic patients consumed more animal protein, cholesterol, and eggs, and fewer vegetables than did asymptomatic patients. Multivariable-adjusted regression analyses also indicated that the risk for symptoms was positively associated with intake of animal protein, cholesterol, and eggs, but negatively associated with intake of vegetables after adjusting for confounders. In addition, symptomatic patients consumed more bread-based breakfast foods, while asymptomatic patients consumed more rice. Conclusions: Postcholecystectomic syndromes were positively associated with intake of cholesterol, animal protein, and eggs, and negatively associated with intake of vegetables, suggesting that diet was plays a role in postcholecystectomic syndromes.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

References

  1. Schirmer BD, Edge SB, Dix J, Hyser MJ, Hanks JB, Jones RS. Laparoscopic cholecystectomy: treatment of choice for symptomatic cholelithiasis. Ann Surg 1991;213:665-676. https://doi.org/10.1097/00000658-199106000-00018
  2. Jaunoo SS, Mohandas S, Almond LM. Postcholecystectomy syndrome (PCS). Int J Surg 2010;8:15-17. https://doi.org/10.1016/j.ijsu.2009.10.008
  3. Malagelada JR, Go VL, Summerskill WH, Gamble WS. Bile acid secretion and biliary bile acid composition altered by cholecystectomy. Am J Dig Dis 1973;18:455-459. https://doi.org/10.1007/BF01076595
  4. Fort JM, Azpiroz F, Casellas F, Andreu J, Malagelada JR. Bowel habit after cholecystectomy: physiological changes and clinical implications. Gastroenterology 1996;111:617-622. https://doi.org/10.1053/gast.1996.v111.pm8780565
  5. Sciarretta G, Furno A, Mazzoni M, Malaguti P. Post-cholecystectomy diarrhea: evidence of bile acid malabsorption assessed by SeHCAT test. Am J Gastroenterol 1992;87:1852-1854.
  6. Svensson JO, Gelin J, Svanvik J. Gallstones, cholecystectomy, and duodenogastric reflux of bile acid. Scand J Gastroenterol 1986;21:181-187.
  7. Wilson P, Jamieson JR, Hinder RA, et al. Pathologic duodenogastric reflux associated with persistence of symptoms after cholecystectomy. Surgery 1995;117:421-428. https://doi.org/10.1016/S0039-6060(05)80062-5
  8. Meshkinpour H, Mollot M. Sphincter of Oddi dysfunction and unexplained abdominal pain: clinical and manometric study. Dig Dis Sci 1992;37:257-261. https://doi.org/10.1007/BF01308180
  9. Evans PR, Dowsett JF, Bak YT, Chan YK, Kellow JE. Abnormal sphincter of Oddi response to cholecystokinin in postcholecystectomy syndrome patients with irritable bowel syndrome: the irritable sphincter. Dig Dis Sci 1995;40:1149-1156. https://doi.org/10.1007/BF02064214
  10. Yueh TP, Chen FY, Lin TE, Chuang MT. Diarrhea after laparoscopic cholecystectomy: associated factors and predictors. Asian J Surg 2014;37:171-177. https://doi.org/10.1016/j.asjsur.2014.01.008
  11. Cummings JH, Wiggins HS, Jenkins DJ, et al. Influence of diets high and low in animal fat on bowel habit, gastrointestinal transit time, fecal microflora, bile acid, and fat excretion. J Clin Invest 1978;61:953-963. https://doi.org/10.1172/JCI109020
  12. Arlow FL, Dekovich AA, Priest RJ, Beher WT. Bile acid-mediated postcholecystectomy diarrhea. Arch Intern Med 1987;147:1327-1329. https://doi.org/10.1001/archinte.1987.00370070139021
  13. Fisher M, Spilias DC, Tong LK. Diarrhoea after laparoscopic cholecystectomy: incidence and main determinants. ANZ J Surg 2008;78:482-486. https://doi.org/10.1111/j.1445-2197.2008.04539.x
  14. Johnson AG. Gallstones and flatulent dyspepsia: cause or coincidence? Postgrad Med J 1971;47:767-772. https://doi.org/10.1136/pgmj.47.554.767
  15. Carvalho RV, Lorena SL, Almeida JR, Mesquita MA. Food intolerance, diet composition, and eating patterns in functional dyspepsia patients. Dig Dis Sci 2010;55:60-65. https://doi.org/10.1007/s10620-008-0698-8
  16. Stanghellini V, Tosetti C, Paternico A, et al. Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology 1996;110:1036-1042. https://doi.org/10.1053/gast.1996.v110.pm8612991
  17. Ministry of Health and Welfare. Korea National Health and Nutrition Examination Survey [Internet]. Sejong (KR): Ministry of Health and Welfare; c2011 [cited 2017 Sep 11]. Available from: http://knhanes.cdc.go.kr/.
  18. Smith MJ, Cherian P, Raju GS, Dawson BF, Mahon S, Bardhan KD. Bile acid malabsorption in persistent diarrhoea. J R Coll Physicians Lond 2000;34:448-451.
  19. Reddy BS, Mangat S, Sheinfil A, Weisburger JH, Wynder EL. Effect of type and amount of dietary fat and 1,2-dimethylhydrazine on biliary bile acids, fecal bile acids, and neutral sterols in rats. Cancer Res 1977;37:2132-2137.
  20. Watson RG, Love AH. Gastric emptying in patients with flatulent dyspepsia, with and without gallbladder disease. Scand J Gastroenterol 1987;22:47-53.
  21. Pelletier X, Thouvenot P, Belbraouet S, et al. Effect of egg consumption in healthy volunteers: influence of yolk, white or whole-egg on gastric emptying and on glycemic and hormonal responses. Ann Nutr Metab 1996;40:109-115. https://doi.org/10.1159/000177903
  22. Burn-Murdoch RA, Fisher MA, Hunt JN. The slowing of gastric emptying by proteins in test meals. J Physiol 1978;274:477-485. https://doi.org/10.1113/jphysiol.1978.sp012161
  23. Uchida K, Nomura Y, Kadowaki M, Takeuchi N, Yamamura Y. Effect of dietary cholesterol on cholesterol and bile acid metabolism in rats. Jpn J Pharmacol 1977;27:193-204. https://doi.org/10.1254/jjp.27.193
  24. Hutcheon DF, Bayless TM, Gadacz TR. Postcholecystectomy diarrhea. JAMA 1979;241:823-824. https://doi.org/10.1001/jama.1979.03290340041024
  25. Chang FY, Chen PH, Wu TC, et al. Prevalence of functional gastrointestinal disorders in Taiwan: questionnaire-based survey for adults based on the Rome III criteria. Asia Pac J Clin Nutr 2012;21:594-600.
  26. Kern F Jr, Birkner HJ, Ostrower VS. Binding of bile acids by dietary fiber. Am J Clin Nutr 1978;31:S175-S179. https://doi.org/10.1093/ajcn/31.10.S175
  27. Adiotomre J, Eastwood MA, Edwards CA, Brydon WG. Dietary fiber: in vitro methods that anticipate nutrition and metabolic activity in humans. Am J Clin Nutr 1990;52:128-134. https://doi.org/10.1093/ajcn/52.1.128
  28. Marciani L, Pritchard SE, Hellier-Woods C, et al. Delayed gastric emptying and reduced postprandial small bowel water content of equicaloric whole meal bread versus rice meals in healthy subjects: novel MRI insights. Eur J Clin Nutr 2013;67:754-758. https://doi.org/10.1038/ejcn.2013.78
  29. Benini L, Sembenini C, Salandini L, Dall'O E, Bonfante F, Vantini I. Gastric emptying of realistic meals with and without gluten in patients with coeliac disease: effect of jejunal mucosal recovery. Scand J Gastroenterol 2001;36:1044-1048. https://doi.org/10.1080/003655201750422639
  30. Biesiekierski JR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol 2011;106:508-514. https://doi.org/10.1038/ajg.2010.487
  31. Ruhl CE, Everhart JE. Relationship of non-alcoholic fatty liver disease with cholecystectomy in the US population. Am J Gastroenterol 2013;108:952-958. https://doi.org/10.1038/ajg.2013.70
  32. Nervi F, Arrese M. Cholecystectomy and NAFLD: does gallbladder removal have metabolic consequences? Am J Gastroenterol 2013;108:959-961. https://doi.org/10.1038/ajg.2013.84
  33. Amigo L, Husche C, Zanlungo S, et al. Cholecystectomy increases hepatic triglyceride content and very-low-density lipoproteins production in mice. Liver Int 2011;31:52-64. https://doi.org/10.1111/j.1478-3231.2010.02361.x
  34. Post SM, Groenendijk M, Solaas K, Rensen PC, Princen HM. Cholesterol 7alpha-hydroxylase deficiency in mice on an APOE*3-Leiden background impairs very-low-density lipoprotein production. Arterioscler Thromb Vasc Biol 2004;24:768-774. https://doi.org/10.1161/01.ATV.0000121572.21122.59
  35. Koo SH. Nonalcoholic fatty liver disease: molecular mechanisms for the hepatic steatosis. Clin Mol Hepatol 2013;19:210-215. https://doi.org/10.3350/cmh.2013.19.3.210
  36. Zweers SJ, Booij KA, Komuta M, et al. The human gallbladder secretes fibroblast growth factor 19 into bile: towards defining the role of fibroblast growth factor 19 in the enterobiliary tract. Hepatology 2012;55:575-583. https://doi.org/10.1002/hep.24702
  37. Bhatnagar S, Damron HA, Hillgartner FB. Fibroblast growth factor-19, a novel factor that inhibits hepatic fatty acid synthesis. J Biol Chem 2009;284:10023-10033. https://doi.org/10.1074/jbc.M808818200
  38. Feng B, Song Q. Does the common bile duct dilate after cholecystectomy? Sonographic evaluation in 234 patients. AJR Am J Roentgenol 1995;165:859-861. https://doi.org/10.2214/ajr.165.4.7676981
  39. Edmunds R, Katz S, Garciano V, Finby N. The common duct after cholecystectomy: interval report. Arch Surg 1971;103:79-81. https://doi.org/10.1001/archsurg.1971.01350070105025
  40. Le Quesne LP, Whiteside CG, Hand BH. The common bile duct after cholecystectomy. Br Med J 1959;1:329-332. https://doi.org/10.1136/bmj.1.5118.329

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