Diagnosis and treatment of post-cholecystectomy diarrhoea

Table 1 Treatment of post-cholecystectomy bile acid diarrhoea

Treatment	Target	Limited
Bile acid sequestrant trial	Bile acids secreted into the intestine are bound to reduce damage to intestinal tissues	Poorly tolerated due to stomach pain, bloating, flatulence, nausea and vomiting
Bile acid receptor agonists	Receptor agonists reduce bile acid synthesis to relieve symptoms of diarrhoea	Potent FXR agonists may have adverse side effects
Glucagon-like peptide 1 receptor agonist	Slows upper gastrointestinal motility and increases small intestine transit time	Further clinical trials and follow-up required
Intestinal microbiota	Increased bile acid binding, excretion in faeces, and hepatic synthesis via an FGF-dependent mechanism after probiotic administration	Not intended to target the entire intestinal microbial community as a therapeutic approach
Ursodeoxycholic acid	Reduces mucosal cytokine levels, inhibiting release of antimicrobial peptides and preventing apoptosis.	LCA metabolism may be required to allow full pharmacological effects of ursodeoxycholic acid
Anti-diarrhoeal agents	Inhibit intestinal secretion and peristalsis, slowing intestinal transit and allowing increased fluid reabsorption to alleviate diarrheal symptoms	High doses or abuse may cause cardiotoxicity
Dietary therapy	Vegetable dietary fiber prevents gastrointestinal diarrhea by reducing gastric emptying	May respond to a reduction of dietary cholesterol and fats