Glossary -
Cholecystectomy - The surgical removal of the gall bladder
https://www.ncbi.nlm...pubmed/19337637
J Gastrointestin Liver Dis. 2009 Mar;18(1):67-71.
Postcholecystectomy syndrome - an algorithmic approach.
BACKGROUND AND AIM:
The postcholecystectomy syndrome includes a heterogeneous group of diseases, usually presenting as abdominal symptoms following gallbladder removal. The clinical management of these patients is frequently without an evidence-based approach.
METHOD:
We evaluated 80 patients with postcholecystectomy problems consecutively admitted during a period of 36 months. The liver function tests (LFTs) assessment and transabdominal ultrasound (TUS) were followed by endoscopic ultrasound (EUS). Endoscopic retrograde cholangio-pancreatography (ERCP) was then performed depeding on the results. With knowledge of the final diagnosis, the probable evaluation and outcomes were reassessed assuming that ERCP would have been performed as the initial procedure. Final diagnosis was confirmed by a combination of imaging findings, as well as clinical follow-up of 6 months.
RESULTS:
In 53 patients biliary or pancreatic diseases were diagnosed: common bile duct stones, chronic pancreatitis, pancreatic cancer, papillary tumors, cholangiocarcinoma, insufficient cholecystectomy or sphincter of Oddi dysfunction. The other 27 patients had non-biliary symptoms (dyspepsia, IBS, etc.) and were consequently managed according to the symptoms. The sensitivity and specificity of EUS were high in the subgroup of patients with biliary or pancreatic symptoms (96.2% and 88.9%) and helped to indicate subsequent ERCP.
CONCLUSION:
An algorithmic approach which used EUS for the initial evaluation of the patients with postcholecystectomy problems decreased the number of ERCPs by 51%, having as a consequence a decreased morbidity and mortality in this group of patients.
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https://www.ncbi.nlm.../pubmed/7729279
Dig Dis Sci. 1995 May;40(5):1149-56.
Abnormal sphincter of Oddi response to cholecystokinin in postcholecystectomy syndrome patients with irritable bowel syndrome. The irritable sphincter.
Abstract
Standard biliary manometry, including cholecystokinin (CCK) provocation, was performed on 42 consecutive patients (36 F, 6 M, median age 45 years) with postcholecystectomy syndrome (PCS) who had no evidence of organic disease but who had objective clinical features suggesting sphincter of Oddi dysfunction (SOD) (classes I and II). Patients were subdivided into those with (N = 14) and without (N = 28) irritable bowel syndrome (IBS) using a validated symptom questionnaire based on the modified Rome criteria. Resting sphincter of Oddi (SO) motor parameters (basal pressure, contractile amplitude and frequency, and proportion of retrograde contractions), the presence of abnormal manometry, and the presence of an abnormal response to CCK were compared in the two groups. No significant differences in resting parameters of SO motor activity between patients with and without IBS were observed, and abnormal biliary manometry as a whole was not more prevalent in either group (8/13 and 18/27, respectively). An abnormal response to CCK (failure of complete inhibition of phasic contractions), however, was demonstrated in five of 12 patients with IBS compared with only one of 23 patients without IBS (P = 0.01). In patients with postcholecystectomy SOD, an abnormal response of the SO to CCK thus appears to be an important feature of the subset of patients with concomitant IBS.
Note - That is 33% who had IBS.
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https://www.ncbi.nlm...les/PMC3335764/
Aliment Pharmacol Ther.
Biliary events and an increased risk of new onset irritable bowel syndrome: A population-based cohort study
Background
Prospective data are lacking to determine if IBS a risk factor for cholecystectomy, or if biliary disease and cholecystectomy predisposes to the development of IBS.
Methods
Validated symptom surveys sent to cohorts of Olmsted County, MN, (1988–1994) with follow-up in 2003. Medical histories were reviewed to determine any “biliary events” (defined by gallstones or cholecystectomy). Analyses examined: 1) time to a biliary event post initial survey and separately, 2) risk of IBS (Rome II) in those with vs. without a prior biliary event.
Results
1908 eligible subjects mailed a follow-up survey. For aim 1) of the 726 without IBS at initial survey, 44 (6.1%) had biliary events during follow up, in contrast to 5 of 93 (5.4%) with IBS at initial survey (HR 0.8, 95% CI 0.3-2.1). For aim 2) of the 59 subjects with a biliary event at initial survey, 10 (17%) reported new IBS on the follow-up survey, while in 682 without a biliary event up to 1.5 years prior to the second survey, 58 (8.5%) reported IBS on follow-up (OR=2.2, 95% CI 1.1-4.6, p=0.03).
Conclusion
There is an increased risk of new IBS in community subjects who have been diagnosed as having a biliary event.
Note - apparently fairly common after cholecystectomy (removal of Gall Bladder). I think you are on to somethin g here.
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https://www.ncbi.nlm...pubmed/25761193
Having the gall bladder removed in patients with gall bladder issues reduced the presence of depression.
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https://www.ncbi.nlm...pubmed/26053886
PLoS One. 2015 Jun 8;10(6):e0129962. doi: 10.1371/journal.pone.0129962. eCollection 2015.
Increased Risk of Depressive Disorder following Cholecystectomy for Gallstones.
Abstract
BACKGROUND:
Prior studies indicate a possible association between depression and cholecystectomy, but no study has compared the risk of post-operative depressive disorders (DD) after cholecystectomy. This retrospective follow-up study aimed to examine the relationship between cholecystectomy and the risk of DD in patients with gallstones in a population-based database.
METHODS:
Using ambulatory care data from the Longitudinal Health Insurance Database 2000, 6755 patients who received a first-time principal diagnosis of gallstones at the emergency room (ER) were identified. Among them, 1197 underwent cholecystectomy. Each patient was then individually followed-up for two years to identify those who were later diagnosed with DD. Cox proportional hazards regressions were performed to estimate the risk of developing DD between patients with gallstone who did and those who did not undergo cholecystectomy.
RESULTS:
Of 6755 patients with gallstones, 173 (2.56%) were diagnosed with DD during the two-year follow-up. Among patients who did and those who did not undergo cholecystectomy, 3.51% and 2.36% later developed depressive disorder, respectively. After adjusting for the patient's sex, age and geographic location, the hazard ratio (HR) of DD within two years of gallstone diagnosis was 1.43 (95% CI, 1.02-2.04) for patients who underwent cholecystectomy compared to those who did not. Females, but not males, had a higher the adjusted HR of DD (1.61; 95% CI, 1.08-2.41) for patients who underwent cholecystectomy compared to those who did not.
CONCLUSIONS:
There is an association between cholecystectomy and subsequent risk of DD among females, but not in males.
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https://www.ncbi.nlm...pubmed/27601483
BMJ Open. 2016 Sep 6;6(9):e007969. doi: 10.1136/bmjopen-2015-007969.
Does preoperative depression and/or serotonin transporter gene polymorphism predict outcome after laparoscopic cholecystectomy?
Abstract
OBJECTIVE:
To determine whether preoperative psychological depression and/or serotonin transporter gene polymorphism are associated with poor outcomes after the common procedure of laparoscopic cholecystectomy.
DESIGN:
Patients undergoing laparoscopic cholecystectomy were genotyped for the serotonin transporter gene 5-HTTLPR polymorphism and assessed for psychological morbidity before and 6 weeks after surgery. The main outcome was postoperative depression; secondary outcomes included fatigue, perceived pain, quality of life and subjective perception about return to usual.
RESULTS:
Full genetic and psychological data were obtained from 273 out of 330 patients consented to the study (82% female). Significantly fewer people with preoperative depression (Beck Depression Inventory (BDI) score >5) had returned to employment (57% vs 86%, p<0.001) or made a full recovery (11% vs 44%, p<0.001) 6 weeks after surgery. Independent predictors for subjective return to usual after surgery included preoperative depression, body mass index and postoperative pain scores. Independent predictors of postoperative depression included preoperative antidepressant use and preoperative depression. SS genotype was associated with use of antidepressants preoperatively and higher anxiety levels after surgery. However, it was not associated with other salient postoperative psychosocial outcomes.
CONCLUSIONS:
Depressive psychological morbidity preoperatively, pain and body mass index appear to be important factors in predicting recovery after this common surgical procedure. There may be a place to include preoperative brief psychological screening to enable targeted support. Our results suggest that the serotonin transporter gene is unlikely to be a useful clinical predictor of outcome in this group.
TRIAL REGISTRATION NUMBER:
ISRCTN40219584.
Note - If the serotonin transporter gene is not involved with this type of depression than ssri/snri would probably be worthless and might explain your treatment resistant depression.
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https://www.ncbi.nlm...les/PMC5508800/
"In this large population-based cohort study, cholecystectomy was associated with postoperative diarrhoea and stomach pain. Cholecystectomy for gallstone colic was associated with nausea in men. There were no associations between quality of life, symptoms of anxiety and depression, constipation, heartburn, or acid regurgitation."
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Note - From Wiki
Postcholecystectomy syndrome describes the presence of abdominal symptoms after surgical removal of the gallbladder (cholecystectomy), 2 years after the surgery.
Symptoms of postcholecystectomy syndrome may include:[1]
Dyspepsia, ⦁ nausea, and vomiting.
Flatulence, ⦁ bloating, and ⦁ diarrhea.
⦁ Persistent pain in the upper right abdomen.⦁ [2]
Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy,[3] and can be transient, persistent or lifelong.[4][5] The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases.
Chronic diarrhea in postcholecystectomy syndrome is a type of bile acid diarrhea (type 3).[5] This can be treated with a bile acid sequestrant like cholestyramine,[5] colestipol[4] or colesevelam,[8] which may be better tolerated.[9]
Treatment
Some individuals may benefit from diet modification, such as a reduced fat diet, following cholecystectomy. The liver produces bile and the gallbladder acts as reservoir. From the gallbladder, bile enters the intestine in individual portions. In the absence of gallbladder, bile enters the intestine constantly, but in small quantities. Thus, it may be insufficient for digestion of fatty foods. Postcholecystectomy syndrome treatment depends on the identified violations that led to it. Typically, the patient is recommended dietary restriction table with fatty foods, enzyme preparations, antispasmodics, sometimes cholagogue.[10]
If the pain is caused by biliary microlithiasis, oral ursodeoxycholic acid can alleviate the condition.[7]
A trial of bile acid sequestrant therapy is recommended for bile acid diarrhoea.[4][9]
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? When will nausea pass? 
