Cholelithiasis, Gut Microbiota and Bile Acids after Bariatric Surgery-Can Cholelithiasis Be Prevented by Modulating the Microbiota? A Literature Review

Abstract

Background: Cholelithiasis is one of the more common complications following bariatric surgery. This may be related to the rapid weight loss during this period, although the exact mechanism of gallstone formation after bariatric surgery has not been fully elucidated.

Methods: The present literature review focuses on risk factors, prevention options and the impact of the gut microbiota on the development of gallbladder stones after bariatric surgery.

Results: A potential risk factor for the development of cholelithiasis after bariatric surgery may be changes in the composition of the intestinal microbiota and bile acids. One of the bile acids-ursodeoxycholic acid-is considered to reduce the concentration of mucin proteins and thus contribute to reducing the formation of cholesterol crystals in patients with cholelithiasis. Additionally, it reduces the risk of both asymptomatic and symptomatic gallstones after bariatric surgery. Patients who developed gallstones after bariatric surgery had a higher abundance of Ruminococcus gnavus and those who did not develop cholelithiasis had a higher abundance of Lactobacillaceae and Enterobacteriaceae.

Conclusion: The exact mechanism of gallstone formation after bariatric surgery has not yet been clarified. Research suggests that the intestinal microbiota and bile acids may have an important role in this.

Keywords: bariatric surgery; bile acids; cholelithiasis; gallstone; microbiota; obesity; ursodeoxycholic acid.

Figure 1

Synthesis of the bile acids and microbial transformation [37,38]. CA—cholic acid; CDCA—chenodeoxycholic acid; TCA—taurocholic acid; GCA—glycocholic acid; TCDCA—taurochenodeoxycholic acid; GCDCA—glycochenodeoxycholic acid; BSH—bile salt hydrolase; DCA—deoxycholic acid; LCA—lithocholic acid; UDCA—ursodeoxycholic acid; HSDH—hydroxysteroid dehydrogenase; BA—bile acids. Created with BioRender.com.