Changes in gut microbiota composition and diversity associated with post-cholecystectomy diarrhea

BACKGROUND Post-cholecystectomy diarrhea(PCD)frequently occurs in patients following gallbladder removal.PCD is part of the post-cholecystectomy(PC)syndrome,and is difficult to treat.After cholecystectomy,bile enters the duodenum directly,independent of the timing of meals.The interaction between the bile acids and the intestinal microbes is changed.Therefore,the occurrence of PCD may be related to the change in microbiota.However,little is known about the relationship between the gut microbiota and PCD.AIM To better understand the role of the gut microbiota in PCD patients.METHODS Fecal DNA was isolated.The diversity and profiles of the gut microbiota were analyzed by performing high-throughput 16S rRNA gene sequencing.The gut microbiota were characterized in a healthy control(HC)group and a PC group.Subsequently,the PC group was further divided into a PCD group and a postcholecystectomy non-diarrhea group(PCND)according to the patients’clinical symptoms.The composition,diversity and richness of microbial communities were determined and compared.RESULTS In the PC and HC groups,720 operational taxonomic units(OTUs)were identified.The PC group had fewer OTUs than the HC group.β-diversity was decreased in the PC group.This indicated decreased microbial diversity in the PC group.Fifteen taxa with differential abundance between the HC and PC groups were identified.In the PCD group compared to the PCND group,significant decreases in microbial diversity,Firmicutes/Bacteroidetes ratio,and richness of probiotic microbiota(Bifidobacterium and Lactococcus),and an increase in detrimental microbiota(Prevotella and Sutterella)were observed.Moreover,a negative correlation was found between Prevotella and Bifidobacterium.Using a Kyoto Encyclopedia of Genes and Genomes functional analysis,it was found that the abundances of gut microbiota involved in lipid metabolism pathways were markedly lower in the PCD group compared to the PCND group.CONCLUSION This study demonstrated that gut dysbiosis may play a critical role in PCD,which provides new insights into therapeutic options for PCD patients.

Alteration of ascending colon mucosal microbiota in patients after cholecystectomy

BACKGROUND Cholecystectomy is a successful treatment option for gallstones,although the inci-dence of colorectal cancer(CRC)has notably increased in post-cholecystectomy(PC)patients.However,it remains uncertain whether the altered mucosal micro-biota in the ascending colon is related.In total,30 PC patients and 28 healthy controls underwent colonoscopies to collect mucosal biopsy samples.PC patients were divided based on their clinical features.Then,16S-rRNA gene sequencing was used to analyze the amplicon,alpha diversity,beta diversity,and composition of the bacterial communities.Addi-tionally,the Phylogenetic Investigation of Communities by Reconstruction of Unobserved States(PICRUSt)database,sourced from the Kyoto Encyclopedia of Genes and Genomes,was used to predict the functional capabilities of the bac-teria.RESULTS PC patients were comparable with healthy controls.However,PC patients older than 60 years had a distinct composition compared to those under 60 years old.Bacteroidetes richness was considerably higher at the phylum level in PC patients.Bacteroides,Parabacteroides,and Bilophila were more abundant in the PC group than in the control group.Furthermore,PC patients exhibited greater enrichment in metabolic pathways,specifically those related to lipopolysaccharide biosynthesis and vancomycin group antibiotic production,than controls.CONCLUSION This study indicated that the mucosal microbiota in PC patients was altered,perhaps offering new perspectives on the treatment possibilities for CRC and diarrhea following cholecystectomy.

Is there a place for endoscopic management in postcholecystectomy iatrogenic bile duct injuries?

In this editorial we comment on the article by Emara et al published in the recent issue of the World Journal of Gastrointestinal Surgery.Previously,surgery was the primary treatment for bile duct injuries(BDI).The treatment of BDI has advanced due to technological breakthroughs and minimally invasive procedures.Endoscopic and percutaneous treatments have largely supplanted surgery as the primary treatment for most instances in recent years.Patient management,including the specific technique,is typically impacted by local knowledge and the kind and severity of the injury.Endoscopic therapy is a highly successful treatment for postoperative benign bile duct stenosis and offers superior long-term outcomes compared to surgical correction.Based on the damage features of BDI,therapeutic options include endoscopic duodenal papillary sphincterotomy,endoscopic nasobiliary drainage,and endoscopic biliary stent implantation.

A retrospective cohort study to examine the association between the persistence of abdominal pain after cholecystectomy and ejection fraction on HIDA scan in patients with biliary dyskinesia

Background and aims:The persistence of pain in patients who underwent cholecystectomy primarily for biliary dyskinesia has been associated with gall bladder ejection fraction(GBEF)found on hepatobiliary iminodiacetic acid(HIDA)scan.Cholecystectomy is a definitive treatment for cholelithiasis but is questionable in biliary dyskinesia.During the postoperative follow-up,gastroenterologists and surgeons often found that some patients with biliary dyskinesia continue to experience biliary pain even after surgery.This study aims to investigate whether the value of GBEF found on the HIDA scan predicts the persistence of pain after cholecystectomy in patients with biliary dyskinesia(EF<35%on HIDA scan).Methods:It is a retrospective cohort study conducted at Kern Medical by recruiting patients from November 2019 to October 2022 in consecutive manner.It is a single sample study consisting of post-cholecystectomy biliary dyskinesia patients with dichotomous outcomes,i.e.,persistent typical recurrent epigastric or right upper quadrant pain with/without meals versus no pain.The primary outcome was the presence of pain 30 days after the cholecystectomy.Univariate analysis was performed with some of the bivariate indicators and continuous predictors,which contained fewer missing elements and had more variation.Results:Univariate logistic regression suggested that HIDA GBEF as a continuous variable does not suggest a relationship with pain after surgery(p=0.3951).A ROC analysis suggested a cutoff of HIDA GBEF=16(AUC=0.60,Specificity=0.5455,Sensitivity=0.7333).Conclusion:Our study does not support the relationship between GBEF found on HIDA scan to improved outcomes after the surgery.But larger controlled trials comparing outcomes of the patients with biliary dyskinesia who did and didn't undergo cholecystectomy are needed to look for other factors.