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

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

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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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 (rs 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.

Original language	English
Journal	Colorectal Disease
Volume	25
Issue	4
Pages (from-to)	600-607
Number of pages	8
ISSN	1462-8910
DOIs	https://doi.org/10.1111/codi.16409
Publication status	Published - Apr 2023

Keywords

bile acid malabsorption
bowel dysfunction
colon cancer
right-sided hemicolectomy
small intestinal bacterial overgrowth
Colectomy/adverse effects
Diarrhea/etiology
Humans
Breath Tests
Bile Acids and Salts
Case-Control Studies
Colonic Neoplasms/complications

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Colorectal Disease - 2022 - Larsen - Chronic loose stools following right‐sided hemicolectomy for colon cancer and theFinal published version, 2.03 MBLicence: CC BY-NC-ND

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Larsen, H. M., Krogh, K., Borre, M., Gregersen, T., Mejlby Hansen, M., Arveschoug, A. K., Christensen, P., Drewes, A. M., Emmertsen, K. J., Laurberg, S., & Ladefoged Fassov, J. (2023). Chronic loose stools following right-sided hemicolectomy for colon cancer and the association with bile acid malabsorption and small intestinal bacterial overgrowth. Colorectal Disease, 25(4), 600-607. https://doi.org/10.1111/codi.16409

@article{f7281e4a70bd43b3b9f0db5752b34859,

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

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

author = "Larsen, {Helene Mathilde} and Klaus Krogh and Mette Borre and Tine Gregersen and {Mejlby Hansen}, Mette and Arveschoug, {Anne K.} and Peter Christensen and Drewes, {Asbj{\o}rn Mohr} and Emmertsen, {Katrine J{\o}ssing} and S{\o}ren Laurberg and {Ladefoged Fassov}, Janne",

year = "2023",

month = apr,

doi = "10.1111/codi.16409",

language = "English",

volume = "25",

pages = "600--607",

journal = "Colorectal Disease",

issn = "1462-8910",

publisher = "John Wiley & Sons Inc.",

number = "4",

}

Larsen, HM , Krogh, K , Borre, M , Gregersen, T , Mejlby Hansen, M, Arveschoug, AK, Christensen, P , Drewes, AM , Emmertsen, KJ , Laurberg, S & Ladefoged Fassov, J 2023, 'Chronic loose stools following right-sided hemicolectomy for colon cancer and the association with bile acid malabsorption and small intestinal bacterial overgrowth', Colorectal Disease, vol. 25, no. 4, pp. 600-607. https://doi.org/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. / Larsen, Helene Mathilde ; Krogh, Klaus ; Borre, Mette et al.
In: Colorectal Disease, Vol. 25, No. 4, 04.2023, p. 600-607.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Chronic loose stools following right-sided hemicolectomy for colon cancer and the association with bile acid malabsorption and small intestinal bacterial overgrowth

AU - Larsen, Helene Mathilde

AU - Krogh, Klaus

AU - Borre, Mette

AU - Gregersen, Tine

AU - Mejlby Hansen, Mette

AU - Arveschoug, Anne K.

AU - Christensen, Peter

AU - Drewes, Asbjørn Mohr

AU - Emmertsen, Katrine Jøssing

AU - Laurberg, Søren

AU - Ladefoged Fassov, Janne

PY - 2023/4

Y1 - 2023/4

N2 - 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 (rs 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.

AB - 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 (rs 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.

KW - bile acid malabsorption

KW - bowel dysfunction

KW - colon cancer

KW - right-sided hemicolectomy

KW - small intestinal bacterial overgrowth

KW - Colectomy/adverse effects

KW - Diarrhea/etiology

KW - Humans

KW - Breath Tests

KW - Bile Acids and Salts

KW - Case-Control Studies

KW - Colonic Neoplasms/complications

UR - http://www.scopus.com/inward/record.url?scp=85142610269&partnerID=8YFLogxK

U2 - 10.1111/codi.16409

DO - 10.1111/codi.16409

M3 - Journal article

C2 - 36347822

AN - SCOPUS:85142610269

SN - 1462-8910

VL - 25

SP - 600

EP - 607

JO - Colorectal Disease

JF - Colorectal Disease

IS - 4

ER -

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

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