THE POSTCHOLECYSTECTOMY SYNDROME - A ROLE FOR DUODENOGASTRIC REFLUX

We have assessed the relationship between dyspepsia and gallstones and evaluated the effects of cholecystectomy on symptoms, endoscopic find ings, and degree of duodenogastric reflux. Thirty patients with gallst ones were enrolled in our study. Their symptoms, gastroscopic findings , and bile salt concentrations in fasting gastric juice were evaluated before and after surgery. Before cholecystectomy, biliary colic was p resent in 26 patients and dyspepsia in 20 patients; 16 patients also h ad biliary colic. After surgery, biliary colic disappeared in all pati ents. Dyspeptic symptoms improved in 12 patients (40%), 13 (43%) remai ned the same, and five patients (17%) developed dyspepsia or showed in crease in their symptoms, the postcholecystectomy syndrome (PCS). Endo scopic gastritis developed in 50% after surgery compared with 30% befo re. Benign gastric ulcers developed in three patients, whereas none ha d been present before. Concentration of bile salts in fasting gastric juice increased from 0.56 +/- 0.4 mM to 1.47 +/- 0.75 mM after cholecy stectomy (p < 0.0001). There was a positive correlation between the se verity of symptoms in the postcholecystectomy syndrome and the change in the concentration of bile salts in fasting gastric juice (p = 0.001 2). These observations suggest that duodenogastric reflux may play a s ignificant role in the pathogenesis of symptoms in the postcholecystec tomy syndrome.