Diagnosis And Pathogenesis Of The Post-Cholecystectomy Diarrhoea

OBJETIVE:The aim of this study was to determine the prevalence of postcholecystectomy diarrhoea (PCD) and to identify that the patient’s clinical characterristics could be used as diagnostic criteria and predictors in daily practice.METHODS:A total of500non-elective consecutive cholecystectomy patients discharged naturally from hospital (inpatient group) and200consecutive cholecystectomy patients complained with digestive disorder in out patient department (opt group) participated in the trial. Clinical data were obtained from clinical records and telephone survey. The prevalence of PCD and clinical characteristic were studied with modified questionnaire basing Gastrointestinal Symptoms Rating Scale (GSRS) and compared with irritable bowel syndrome. Patient’s basic material, clinical routine test before and after operation were estimated as a mark to predicate the PCD.RESULTS:The overall incidence of PCD was13.7%%(57/397) in the inpatient group and32.9%(64/194) in the opt group. Morning diarrhoea, urgent need for defecation, bearing-down pain in the anus were the most common symptoms and were reported by65.5%,62.5%and76.5%in ops patients, respectively. Stools routine test and colonoscopy were normal in most of patients. There were no differences between the inpatients and opt group regarding age,gender, B ultrasonic imagery date,biochemical test, model operation,time of operation and admission in hospital pre-and post-operatively.CONCLUSION：PCD is common and has higher incidence in patients with postcholecystectomy. Morning diarrhoea, urgent need for defecation and bearing-down pain in the anus is the characteristic picture which could be used clinically as the diagnostic criteria of PCD. Patient’s basic material, clinical routine test before operation couldn’t be used as a predicator to make the diagnosis of PCD. OBJETIVE：The aim of this study was to investigate the pathogenesis with post-cholecystectomy diarrhoea (PCD).METHODS：96clean healthy ICR mice, weigh38±3g,were randomly divided into6groups: normal control group (A), cholecystectomy group(B), high dose hydrotalcite group(C), medium dose hydrotalcite group(D), low dose hydrotalcite group(E) and colestyramine group(F). The mice in A group, as the obstructive group, weren’t given cholecystectomy. The mice in other groups were given cholecystectomy. When the incision had been completely healed and diet had been recovered to normal in the three weeks, the mice were provided hydrotalcite, colestyramine and physiological saline by intragastric administration for one week. A and B group were administered5%NS (0.1ml/10g.w), C,D and E groups were administered hydrotalcite with high, middle and low does of258,86and28.7mg/ml (0.1ml/10g.w) respectively, F group was administered colestyramine78mg/ml(0.1ml/10g.w). The body weight, the water content of feces and bile acid of feces were measured in preoperative, postoperative and post-administer. All of the mice were sacrificed by breaking neck after one week and the colon of the mice was excised for pathologic research, including mucosal thickness, morphology changes and the pathological histological grading.RESULTS:71mice were successfully survived after operation.15,10,12,12,12and10mice were entered in A, B, C, D, E and F group respectively. Compared with normal group, the water content of feces and bile acid of feces were increased in cholecystectomy group (P<0.05). Before oral hydrotalcite the thicker of colon mucous membrane, and the pathological histological grading (inflammatory cell infiltrated in the submucosa) were significantly raised in B, C, D, E and F group respectively (P<0.05).We found that the water, bile acid of mice feces were decreased, the thicker of colon mucous membrane was lowered and infiltrated inflammatory cell in the submucosa were reduced in oral hydrotalcite groups. The effects of high doses of hydrotalcite were more effective than the middle and low doses of hydrotalcite and colestyramine in controlling the diarrhea. CONCLUSION:The increased water and bile acid of feces, the thicker colon mucous membrane, and the raised infiltrated inflammatory cell in the submucosa of mice may be the possible pathogenesis of PCD. By absorbing bile acid, improve the inflammatory reactions; the hydrotalcite can improve the diarrhea after cholecystectomy in mice.