Chronic loose stools following right-sided hemicolectomy for colon cancer and the association with bile acid malabsorption and small intestinal bacterial overgrowth

Helene Mathilde Larsen; Klaus Krogh; Mette Borre; Tine Gregersen; Mette Mejlby Hansen; Anne K Arveschoug; Peter Christensen; Asbjørn Mohr Drewes; Katrine Jøssing Emmertsen; Søren Laurberg; Janne Ladefoged Fassov

doi:10.1111/codi.16409

Chronic loose stools following right-sided hemicolectomy for colon cancer and the association with bile acid malabsorption and small intestinal bacterial overgrowth

Colorectal Dis. 2023 Apr;25(4):600-607. doi: 10.1111/codi.16409. Epub 2022 Nov 23.

Authors

Helene Mathilde Larsen^{1

2}, Klaus Krogh^{1

3}, Mette Borre^{1

3}, Tine Gregersen⁴, Mette Mejlby Hansen³, Anne K Arveschoug⁴, Peter Christensen^{1

2}, Asbjørn Mohr Drewes^{1

5}, Katrine Jøssing Emmertsen^{1

6}, Søren Laurberg^{1

2}, Janne Ladefoged Fassov^{1

3}

Affiliations

¹ Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, Aarhus and Aalborg, Denmark.
² Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
³ Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
⁴ Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus, Denmark.
⁵ Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
⁶ Department of Surgery, Regional Hospital Randers, Randers, Denmark.

PMID: 36347822
DOI: 10.1111/codi.16409

Abstract

Aim: Patients treated with right-sided hemicolectomy for colon cancer may suffer from long-term bowel dysfunction, including loose stools, urgency and faecal incontinence. The underlying causes are poorly understood. The aim of this case-control study was to investigate the aetiology of chronic loose stools among patients with right-sided hemicolectomy curatively operated for cancer.

Method: Cases with chronic loose stools (Bristol stool type 6-7) after right-sided hemicolectomy were compared with a control group of patients with right-sided hemicolectomy without loose stools. All patients underwent a selenium-75 homocholic acid taurine (SeHCAT) scan to diagnose bile acid malabsorption (BAM) and a glucose breath test to diagnose small intestinal bacterial overgrowth (SIBO). Gastrointestinal transit time (GITT) was assessed with radiopaque markers. In a subgroup of patients, fibroblast growth factor 19 (FGF19) was measured in fasting blood. SIBO was treated with antibiotics and BAM was treated with bile acid sequestrants.

Results: We included 45 cases and 19 controls. In the case group, 82% (n = 36) had BAM compared with 37% (n = 7) in the control group, p < 0.001. SIBO was diagnosed in 73% (n = 33) of cases with chronic loose stools and in 74% (n = 14) of controls, p = 0.977. No association between BAM and SIBO was observed. GITT was similar in cases and controls. No difference in median FGF19 was observed between cases and controls (p = 0.894), and no correlation was seen between FGF19 and SeHCAT retention (r_s 0.20, p = 0.294). Bowel symptoms among cases were reduced after treatment.

Conclusion: BAM and SIBO are common in patients having undergone right-sided hemicolectomy for cancer. Chronic loose stools were associated with BAM but not with SIBO.

Keywords: bile acid malabsorption; bowel dysfunction; colon cancer; right-sided hemicolectomy; small intestinal bacterial overgrowth.

MeSH terms

Bile Acids and Salts*
Breath Tests
Case-Control Studies
Colectomy / adverse effects
Colonic Neoplasms* / complications
Diarrhea / etiology
Humans

Substances

Bile Acids and Salts
23-seleno-25-homotaurocholic acid

Abstract

MeSH terms

Substances

Grants and funding