Irregular bowel movement in gastrectomized subjects: bowel habits, stool characteristics, fecal flora, and metabolites

We conducted a survey regarding irregular bowel movement in gastrectomized patients. Their defecation frequency, intestinal microflora, and intestinal environment were studied and compared with those of healthy controls. As a first step, a questionnaire survey on bowel movement, involving 769 patients and 312 healthy controls (total: 1,081 subjects), was carried out. As a second step, the defecation frequency (scoring of the survey results conducted to evaluate the state of constipation/diarrhea), intestinal microflora, and intestinal environment were evaluated in 190 gastrectomized patients with irregular bowel movement and 31 controls identified in the first survey. First step: Of the 769 patients, 58% complained of irregular bowel movements (constipation, diarrhea, or their alternate occurrence), and their frequency of complaints was significantly higher (p < 0.01) than that in the healthy controls (33%). Second step: The levels of the most predominant obligate anaerobe and harmful bacteria in the feces were lower and higher, respectively, the fecal pH was lower, the fecal water content was lower, and the level of putrefactive metabolites in the feces was higher in the gastrectomized patients than in the healthy controls. The intestinal flora and environment were more disrupted in the totally gastrectomized than in the partially gastrectomized patients. Many gastrectomized patients with irregular bowel movements exhibited significant changes showing impaired intestinal microflora and metabolite levels.