Effect of Post-Cholecystectomy on Small Intestinal Bacterial Overgrowth and Orocecal Transit Time in Gallstone Patients

Background: Effect of duration of cholecystectomy on orocecal transit time and small intestinal bacterial overgrowth in gallstone patients is poorly understood. Method: 128 gallstone patients of either sex, aged between 25-68 years were enrolled. 79/128 followed after 4-6 months of cholecystectomy. 49 patients had undergone cholecystectomy 2 - 15years before study and reported gastrointestinal symptoms, classified as late post-cholecystectomy. Orocecal transit time (OCTT) and small intestinal bacterial overgrowth (SIBO) were measured by non-invasive lactulose and glucose breath tests respectively. Results: OCTT increased significantly (p < 0.01) from 125.9 ± 28.6 to 145.8 ± 30.5 minutes after 4-6 months of cholecystectomy. Among late post-cholecystectomy patients, OCTT was observed to be 159.2 ± 37.8 minutes, which was significantly higher when compared with OCTT in pre-cholecystectomy patients. SIBO was present in 10/79 (12.7%) gallstone patients pre-cholecystectomy and 11/79 (13.9%) in gallstone patients post-cholecystectomy. Presence of SIBO after 4-6 months of cholecystectomy was not significantly different compared to pre-cholecystectomy in gallstone patients. However, SIBO was present in 13 / 49 (26.5%) late post-cholecystectomy patients with duration of 2-15years, which was significantly (p < 0.05) higher compared to pre-cholecystectomy and 4-6months post-cholecystectomy patients. Conclusion: The study signifies that longer duration of post-cholecystectomy can lead to delayed OCTT and cause SIBO in gallstone patients. This can be mitigated by giving pro-kinetics to post-cholecystectomy patients.