The cause and treatment of postvagotomy diarrhoea

Abstract

Six patients with watery postvagotomy diarrhoea and 4 patients with intractable diabetic diarrhoea were treated with cholestyramine. The diarrhoea responded completely to therapy, during which the stool content of water, sodium, postassium and magnesium fell. Two of the patients, while receiving cholestyramine, had a rise in faecal fat, but this was not accompanied by diarrhoea, the stools being well formed. Evidence is presented which suggests that the mechanism of diarrhoea is similar in both disorders and is due to division or neuropathy of the hepatic fibres of the vagus nerve. This results is distension of the gallbladder, contraction of which expels increased quantities of bile salts, which swamp the reabsorptive capacity of the small intestine and induce diarrhoea by direct action on the colon. If this theory is valid, cholecystectomy, by preventing large quantities of concentrated bile salts from suddenly entering the gut, may result in improvement of postvagotomy and diabetic diarrhoea.

Double-Blind Trial of Cholestyramine in Post-Vagotomy Diarrhoea

“…This confirms under double-blind conditions the finding of other workers (Ayulo, 1972;Condon et al, 1974Condon et al, , 1975.…”

“…Dilatation of the gallbladder after vagotomy has been reported by several groups (Johnson and Boyden, 1952;Rudick and Hutchison, 1964). Condon et al (1975) proposed that a dilated gallbladder may play an aetiological role in post-vagotomy diarrhoea by storing excessive volumes of bile salts which swamp the reabsorptive capacity ofthe small intestine on contraction during a meal. They further suggested that cholecystectomy may alleviate the symptoms.…”

“…Other workers have shown that cholestyramine usually results in only a mild increase in faecal fat excretion (Hofmann and Poley, 1969;Condon et al, 1975;West and Lloyd, 1975). However, long-term cholestyramine therapy may result in folate deficiency, low prothrombin time, acidosis, constipation, intestinal obstruction, and osteomalacia (Heaton et al, 1972;West and Lloyd, 1975).…”

“…Another clinical situation in which diarrhoea is reported to respond to cholestyramine is diabetic diarrhoea (Condon et al, 1973(Condon et al, , 1975, and a vagal neuropathy has been postulated. Recently, a further group of patients has been described with a severe diarrhoea who excrete faecal bile salts without any evidence of vagal damage.…”

Obesity diabetes and the role of bile acids in metabolism

“…We showed that these patients have an increased bile salt pool size with alteration in bile salt composition. Cholestyramine, a bile acid sequestrant, has sometimes been successful in treating the condition [56] .…”