A study of the relationship between post-cholecystectomy diarrhea and intestinal microecology

Background and Aims:Cholecystectomy is the preferred surgical procedure for treating gallstones,but the incidence of postcholecystectomy diarrhea (PCD) varies considerably,and its association with the intestinal microbiota remains unclear.This study aims to investigate the effects of cholecystectomy on the gut microbiota and to characterize the intestinal microbiome features in patients with PCD.
Methods:A prospective cohort of 35 patients with gallstones (GS group) was enrolled. Preoperative stool samples were collected, and postoperative follow-up at 3 months yielded stool samples from 26 patients,including 17 who developed postcholecystectomy diarrhea (PCD group). Additionally,17 healthy individuals (HC group) were enrolled as controls.Fecal metagenomic sequencing and non-targeted metabolomics were employed to analyze gut microbiota and metabolite differences across the three groups.
Results:There was no significant difference in α diversity between the GS and HC groups,but statistically significant differences were observed in β diversity at the phylum and genus levels.The PCD group also exhibited significant differences in β diversity at the phylum and genus levels compared to the HC group.Species such as Bacteroidales_unclassified and Parabacteroides_distasonis showed significantly increased abundance in the PCD group,with Bacteroides and Phocaeicola being the primary differential taxa.Metabolomics analysis revealed that Ile-Lys,Fenugreekine, and Metharbital demonstrated excellent diagnostic performance,with area under the ROC curve (AUC) values exceeding 0.9 for distinguishing HC from PCD,and exceeding 0.9 and 0.85 for distinguishing GS from PCD, respectively.
Conclusion:Following cholecystectomy,the intestinal microecological balance is disrupted,and patients with primary cholestatic disease (PCD) exhibit significant gut microbiota dysbiosis.The increased abundance of Parabacteroides distasonis may be closely associated with the development of PCD.