Diarrhea or loose stools is mainly a potential side effect of sleeve gastrectomy with duodenal switch.Diarrhea may be seen with Roux-en-Y gastric bypass,but would not be associated with lap adjustable gastric banding.Post Duodenal switch( DS ),the usual alteration is soft or loose stools.Frank diarrhea is related to fatty acids directly passing into the colon which normally would have been absorbed in the small intestine.Once in the colon they induce irritation.It can also be due to relatively undigested food passing rapidly through the GI tract.A third contributing factor is sorbitol,found in fruits,berries and artificial sweeteners.In the colon it gets fermented.This causes increased gas and diarrhea .The number of loose stools after DS may vary from 2-3 upto 10--20 per day when it becomes really problematic and very inconvenient.Diet is a major influence on bowel movements after DS.Reducing the amount of fat will have a direct beneficial effect on the number and quality of bowel movements.Usually with close questioning some trigger type foods can be identified and avoided.
Both the DS and RNYGBP(Gastric bypass)may unmask previously unidentified lactose intolerance.An early step is to eliminate dairy products completely from the diet. Management of diarrhea(provided there is no identifiable pathologic or dietary factors)is varied.A dose of imodium at bedtime can reduce the early morning onset. If beneficial,some patients stay on a maintainance dose for long term control under doctors supervision.
Many patients may benefit from a course of probiotics.They are a form of natural colonic flora that is administered orally to restore the natural bacterial milieu towards a normal state.In any post operative patients with watery diarrhea,foul flatus and abdominal cramping the doctor may also consider clostridium difficile(c-diff)colitis or antibiotic associated diarrhea.