ALTERED ANTRODUODENAL MOTILITY AFTER CHOLECYSTECTOMY

BACKGROUND: Persistent nonspecific symptoms such as epigastric pain, b loating, nausea, and bilious vomiting are common following cholecystec tomy. The etiology of these symptoms is unknown, but abnormal antroduo denal motility associated with duodenogastric reflux (DGR) is a possib le cause. PATIENTS AND METHODS: Sixteen postcholecystectomy patients a nd 19 healthy volunteers (''normals'') were studied. Ten of the patien ts were asymptomatic and 6 were symptomatic. The study consisted of a 4-hour Tc-99m-DISIDA (diisopropyl imidodiacetic acid) infusion and gas tric aspiration, 24-hour intragastric pH monitoring, and 24-hour ambul atory antroduodenal manometry. RESULTS: The postcholecystectomy patien ts showed increased DGR of the infused Tc-99m-DISIDA. The data are giv en as coulter counts X 10(6)/min. The increase was more marked in symp tomatic postcholecystectomy patients (2.54 +/- 0.15) compared to asymp tomatic patients (1.21 +/- 0.46) or normals (0.26 +/- 0.15). Postchole cystectomy patients had increased percentage of time with intragastric pH > 3. In the supine period in particular, the pH was > 3 in symptom atic patients 25.4% +/- 7.7% of the time versus 8.1% +/- 4.3% for asym ptomatic patients (P < 0.01). The antral phase III frequency after cho lecystectomy was 2.5 +/- 0.09 cycles/min compared to 3.2 +/- 0.08 cycl es/min in normals (P < 0.0001). Furthermore, propagation of the phase III front iu the duodenum was significantly slowed to 0.14 +/- 0.02 cm /s after cholecystectomy compared to 0.27 +/- 0.02 cm/s in normals (P < 0.001). The duration of phase III in the proximal duodenum after cho lecystectomy was also decreased to 4.3 +/- 0.27 min compared to 5.9 +/ - 0.35 min in normals (P < 0.005). CONCLUSIONS: Fasting antroduodenal motility is altered after cholecystectomy. The abnormality is associat ed with increased DGR, which is more marked in symptomatic patients.