Since my cholecystectomy four years ago, I've experienced severe diarrhea immediately after eating. I was prescribed Questran and it pretty much stopped the severe diarrhea. Will I have to take the Questran for the rest of my life? I have tried not taking it, and the diarrhea comes back. Also, are there any side effects from the Questran that I should be concerned about?

Rebekah

Many patients experience diarrhea after gallbladder removal. In fact, it is so common that surgeons often warn patients of this possibility before gallbladder-removal surgery (cholecystectomy). In people who have always had problems with constipation, this loosening of stools may actually be a benefit that leads to more regular bowel habits after surgery. In contrast, patients who had frequent or loose stools before cholecystectomy may experience worsening of their symptoms and significant diarrhea after the operation.

Overall, studies have found about 10-20 percent of patients experience diarrhea after a cholecystectomy. The reason for this is unknown, but several theories have been postulated. The most widely accepted explanation relates to bile acids. Normally the gallbladder stores bile (containing bile acids) in between meals. During a meal, the gallbladder releases its contents into the intestine to facilitate digestion and absorption. The bile acids accomplish this task. After digestion is complete, the bile acids are reabsorbed in the last part of the small intestine. Bile acids that escape absorption can enter the colon, where they can irritate the colon's lining and lead to diarrhea. After a cholecystectomy, there is no storage site for bile in between meals. Bile acids are constantly released into the small intestine and many more can escape into the colon. Thus, diarrhea is more likely to occur.

Another theory holds that gallbladder removal speeds transit of food through the intestine because it short-circuits the nerve networks in the intestine and colon. This theory has not been as widely accepted.

Based on the theory of bile acid injury to the colon, treatment for diarrhea after gallbladder surgery often involves cholestyramine (Questran). By binding bile acids, Questran keeps them from irritating the colon, thereby preventing diarrhea. Although it is generally a safe medication, the possible side effects of Questran include certain vitamin deficiencies, because bile acids are needed for absorption of some vitamins. Questran can also interfere with absorption of certain medications. These must be reviewed with your doctor before you start or stop Questran.

The most common side effects of Questran include bloating, nausea and increased gas. These tend to improve with time. The dosage of Questran should be started low and increased gradually to minimize these annoying side effects. For patients who do not improve with Questran, other medications can be used. These include aluminum-based antacids (which tend to cause constipation), medications to slow intestinal motility, and bulking agents (the various fiber supplements). You should talk with your doctor to determine whether any of these options may be appropriate in your case.