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Bile acid diarrhoea in post-cholecystectomy patients (BADCAP)
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Farrugia, Alexia (2021) Bile acid diarrhoea in post-cholecystectomy patients (BADCAP). MD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3782423
Abstract
Introduction
Bile acid diarrhoea (BAD) can occur due to disruption to the enterohepatic circulation e.g. following cholecystectomy. The mechanism behind BAD after cholecystectomy is as yet unknown. The aim of this work was to determine the rate of post-cholecystectomy diarrhoea and to assess whether FGF19 within the gallbladder was associated with the development of BAD.
Methods
The project was divided into two parts. The first part was a multicentre retrospective audit to assess the rate of investigation of post-cholecystectomy patients. The second part was a prospective case-control study in which patients were assessed pre- and post cholecystectomy (study group) and compared with patients also having keyhole surgery in the abdomen but not cholecystectomy (control group). Their bowel habits and a GIQLI questionnaire was performed to compare the two groups and to compare pre- and post-operative condition. A small subset of these patients also had blood tests.
Results
The multicentre audit found that only 2.1% of patients are investigated for diarrhoea post-cholecystectomy, which contrasts directly with our systematic review stating that 13.3% of patients have post-cholecystectomy diarrhoea. In the case-control study, there were no significant results when assessing the effect of gallbladder FGF19 concentration on bowel habit, stool consistency, lipid levels, BMI or smoking. Gallbladder PPAR α was found to have a significant correlation with stool consistency, with the lower the PPARα concentration the higher the Bristol stool chart number (i.e. looser stool). The study group showed a significant increase in triglycerides post-operatively, however there were no changes in cholesterol, HDL and LDL levels. Correlation of 16 these increased triglyceride levels and GIQLI, stool consistency and bowel habits showed no significant results.
Discussion
We have seen that a smaller percentage of patients is being investigated for diarrhoea than is expected. While there is a general improvement in post operative quality of life, we did not find any direct evidence that FGF19 levels within the gallbladder impact the development of post-cholecystectomy diarrhoea. While we have shown a significant increase in triglycerides postoperatively, there was also no correlation with PPARα. Further work is required particularly relating to the gut microbiome to further investigate this condition.
Item Type: | Thesis (MD) | ||||
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Subjects: | R Medicine > RC Internal medicine | ||||
Library of Congress Subject Headings (LCSH): | Bile acids, Diarrhea -- Etiology, Cholecystectomy -- Complications | ||||
Official Date: | 2021 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | MD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Arasaradnam, Ramesh P. ; Brosens, Jan J. | ||||
Format of File: | |||||
Extent: | 176 leaves : illustrations, charts | ||||
Language: | eng |
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