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What to Eat Post-Cholecystectomy

Education regarding the post cholecystectomy diet should be provided to the patient. Although not a vital organ, the gallbladder has a specific role in the digestive process. Cholecystectomy is definitive therapy in cases of acute cholecystitis or symptomatic cholelithiasis. Removal of the gallbladder during a cholecystectomy can result in changes in the patient's digestive pattern, metabolism, and nutritional status.

Post-Cholecystectomy Physiological Changes
Sometimes, Acute cholecystitis with an onset of 72 hours and recurrent cholecystitis require cholecystectomy. Every day, the liver produces 500-1000 mL of bile and is accommodated by the gallbladder. Metabolism of fat requires bile at a certain volume and concentration; the gall bladder regulates this. The removal of the gallbladder causes bile secretion to flow directly into the duodenum.

This condition can cause changes in the motility of the gastrointestinal tract, causing diarrhea. In addition, the required amount of bile is not achieved, so gastric emptying is slower. This condition can trigger gastritis due to gastroduodenal reflux. Changes in the concentration and secretion of bile are also thought to alter the normal flora of the digestive tract due to cytotoxic and oxidative effects so that it has an impact on metabolic processes, the immune system, and neurohormonal.

Diet Post Cholecystectomy
Until now, there are no specific nutritional guidelines for patients who have undergone removal of the gallbladder. Studies regarding the specific dietary needs of post-cholecystectomy patients are still minimal.

In general, the nutritional recommendations, according to experts for post-cholecystectomy patients, are:
  • A low-fat diet that can be increased slowly over several months by looking at the tolerance of each individual
  • Increase consumption of fiber to help bile so that it can improve gastrointestinal motility
  • Avoid consuming alcohol, caffeine, soft drinks, chocolate, spicy food, and foods and beverages based on citrus, tomatoes, and menthol in patients who experience functional dyspepsia symptoms.
  • A small but frequent diet to help reduce symptoms due to gastroduodenal reflux
  • Oral prebiotic and probiotic supplementation can be considered to help restore normal gastrointestinal flora.
  • Supplementation of fat-soluble vitamins A, D, E, and K is still recommended. However, no study states that post-cholecystectomy patients must be deficient in fat-soluble vitamins A, D, E, and K.


Pharmacological Therapy
Pharmacological therapy for patients who experience gastrointestinal complaints after the cholecystectomy procedure is given according to the complaints and symptoms. Pharmacological therapy that can be given includes:
  1. Loperamide to reduce gastrointestinal motility in patients with recurrent diarrhea
  2. Cholestyramine to decrease gastrointestinal motility by binding to bile in patients who have diarrhea with fatty stools or steatorrhea
  3. Fiber supplementation to reduce diarrhea in patients who lack oral fiber intake
  4. H2 antagonists (cimetidine, ranitidine) or proton pump inhibitors (omeprazole, lansoprazole) given to patients with symptoms of functional dyspepsia due to gastroduodenal reflux


Conclusion
Studies regarding post-cholecystectomy patients' nutritional needs are still very limited; there are no specific dietary guidelines for post-cholecystectomy patients. According to experts, post-cholecystectomy diet recommendations in the form of a low-fat, high-fiber diet, reducing the quantity of food more frequently and avoiding foods and drinks that can trigger an increase in stomach acid production. Pharmacological therapy for patients who have experienced removal of the gallbladder according to complaints and symptoms. The most common complaints are diarrhea and dyspepsia.

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