Na. Abufarsakh et al., THE POSTCHOLECYSTECTOMY SYNDROME - A ROLE FOR DUODENOGASTRIC REFLUX, Journal of clinical gastroenterology, 22(3), 1996, pp. 197-201
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.