Background. The aim of this study was to determine whether increased d
uodenogastric reflux contributes to postcholecystectomy symptoms. Meth
ods. Gastric pH monitoring, hepatobiliary scintigraphy, gastric emptyi
ng scans, and gastric acid analysis were performed in asymptomatic (n
= 10) and in symptomatic (n = 27) patients after cholecystectomy. Norm
al subjects (n = 20), patients with dyspepsia related to gastric acid
hypersecretion (n = 20), patients with reflux gastritis after gastric
surgery (n = 10), and patients with confirmed primary pathologic duode
nogastric reflux (n = 10) were studied as controls. Symptomatic patien
ts also underwent upper gastrointestinal endoscopy. Results. Symptomat
ic patients had significantly increased interprandial gastric exposure
to pH <3 compared with asymptomatic subjects, which correlated well w
ith a high incidence of hepatobiliary scans positive for abnormal duod
enogastric reflux and chronic gastritis on endoscopy. Gastric alkaline
exposure in symptomatic patients was similar to that seen in patients
with primary pathologic duodenogastric reflux and patients with duode
nogastric reflux related to gastric surgery. Gastric acid secretion an
d gastric emptying were not altered. Five patients tested before and a
fter laparoscopic cholecystectomy showed that nocturnal gastric alkali
zation was enhanced after operation. Conclusions. This study suggests
that excessive duodenogastric reflux may be responsible for persistenc
e of symptoms after cholecystectomy.