CHOLELITHIASIS AND BILE-ACID ABSORPTION AFTER TRUNCAL VAGOTOMY AND GASTROENTEROSTOMY

Gallbladder disease in the form of gallstones demonstrated by ultrason ography or previous cholecystectomy was found in 15 of 26 women of med ian age 69 (range 52-82) years who had had truncal vagotomy and gastro enterostomy performed a median of 27 (range 11-30) years previously, c ompared with eight of 31 healthy age- and sex-matched controls drawn f rom the community (P <0.02), Bile acid malabsorption identified by ret ention of 23-selena, 25-homotaurocholate ((75)SeHCAT) occurred in only two of the 26 patients after vagotomy and there was no relationship b etween retention and the presence or absence of gallbladder disease. T he serum concentration of 7 alpha-hydroxycholestenone, an indicator of bile acid turnover, was significantly lower in patients with gallblad der disease after vagotomy than in controls (mean(s.e.m.) 19.1(3.7) ve rsus 31.4(4.4) ng/ml, P<0.05). Bile acid malabsorption does not play a significant role in the pathogenesis of gallstones after vagotomy but decreased bile acid synthesis may be important. There is no correlati on between retention of (75)SeHCAT and 7 alpha-hydroxycholestenone lev els in patients after vagotomy, indicating that bile acid synthesis an d absorption are uncoupled in this situation.