Does cholecystectomy affect antral mucosa? Endoscopic, histopathologic andDNA flow cytometric study

Background/Aims: Although cholecystectomy is still the "gold standard" for treatment of gallstones, this operation may be followed by gastric disorder s. The aim of this study is to detect the effects of cholecystectomy on gas tric antral mucosa. Methodology: This prospective study has been carried out on 46 patients (20 M & 26 F) with mean age 41.7 +/- 0.2 years for whom simple cholecystectomy for gallstones was decided. Prior to the operation and 1 year after, patie nts were subjected to the following: clinical assessment, upper gastro inte stinal endoscopy, histopathology of antral mucosa, detection of H, pylori a nd DNA flow cytometry. Results: There was an increase in the number of patients presenting suggest ive symptoms of reflux gastritis: patients experiencing epigastric pain inc reased from 8 (17.41%) to 11 (23.39%) patients, nausea increased from 6 (13 %) to 12 (26.1%) patients and bilious vomiting increased from 3 (6.5%) to 1 1 (23.9%) patients. Mild antral gastritis increased from 20 (43.5%) to 27 ( 58.7%) patients. Antral gastritis and antral erosions were detected only af ter the operation in 8 (17.4%) and 2 (4.3%) patients, respectively. The inc idence of active chronic superficial gastritis decreased from 23 (50%) to 1 3 (28.2%) patients while the inactive form increased from 15 (32.6%) to 23 (50%) patients. Chronic atrophic gastritis, intestinal metaplasia and dyspl asia were only detected postoperatively in 2 (4.3%) patients each. There wa s a decrease in the incidence of H. pylori infection from 32 (69.6) to 19 ( 41.3%) patients. DNA aneuploid pattern increased from 1 (2.2%)) to 4 (8.7%) patients and there was a significant increase of DNA index from 1.01 (+/- 0.03) to 1.03 (+/- 0.05) (P < 0.005). Conclusions: Changes in clinical, endoscopic and histopathlogic findings su ggest that cholecystectomy may affect gastric antral mucosa due to duodenog astric reflux. Flow cytometry may be used as an objective method for detect ion and evaluation of postcholecystectomy reflux gastritis.