Removal of the gallbladder

Question

Hello,
can the need for enzymes (Kreon, Panzytrat etc) increase after removal of the gallbladder?
Yours sincerely,
A. K.

Answer

Hello,
you ask, if the need for pancreatic enzymes could increase after removal of the gallbladder.
This is quite a justified question. The function of the gallbladder is indeed to keep a storage of larger amount of bile acids for a larger meal, rich in fat. Then the gall can be released in a flush in larger amounts and mixes with the food mush.
The lipases of the tounge and of the stomach hydrolyse to a quite small extent (10-30%) the fats, that are additionally emulgated in the stomach mechanically. The enzymes of the pancreas hydrolize the rest of the still non-hydrolized fats, that forme then with the help of the bile with its bile acids and bile salts so-called micells, via the latter the resorption of fats is possible.
In case the gallbladder is removed, the needed amount of bile acids and bile salts could be too small, especially in case of meals with a high fat content, so that in spite of a sufficient amount of pancreatic enzymes, an insufficient resorption of fats results.
In this situation, an additional intake of pancreatic enzymes does therefore not help, however one should pay attention to the following things:
Prerequisite is a optimal intake of the right amount of pancreatic enzymes. Here it makes possibly sense, to have another counselling from the dietician of the CF center. In case there is no gallbladder, it is of utmost importance to take time for the meals, that the liver has probably enough time to produce sufficient amounts of new bile fluid.
Frequent small meals are another tool to optimize the nutrition in this situation.
Furthermore, you should discuss with your CF physicians, in which form an additional intake of bile salts during the meal could be helpful.
I wish you all the best and keep the fun in eating.

Yours sincerely,
Dr. H.-G. Posselt

13.10.2014