Ultrasound examination shows disturbed proximal gastric function in symptomatic gallstone patients with dyspepsia and improvement after cholecystectomy--gallstones and gastric emptying

The Symptomatic Outcomes of Cholecystectomy for Gallstones

Cholecystectomy is the definite treatment for symptomatic gallstones, and rates are rapidly rising. Symptomatic complicated gallstones are generally treated with cholecystectomy, but there is no consensus on the clinical selection of patients with symptomatic uncomplicated gallstones for cholecystectomy. The aim of this review is to describe symptomatic outcomes before versus after cholecystectomy in patients with symptomatic gallstones as reported in prospective clinical studies and to discuss patient selection for cholecystectomy. Following cholecystectomy, resolution of biliary pain is high and reported for 66-100%. Dyspepsia has an intermediate resolution of 41-91% and may co-exist with biliary pain but may also develop following cholecystectomy with an increase of 150%. Diarrhea has a high increase and debuts in 14-17%. Persisting symptoms are mainly determined by preoperative dyspepsia, functional disorders, atypical pain locations, longer duration of symptoms, and poor psychological or physical health. Patient satisfaction following cholecystectomy is high and may reflect symptom alleviation or a change in symptoms. Comparison of symptomatic outcomes in available prospective clinical studies is limited by variations in preoperative symptoms, clinical presentations, and clinical management of post-cholecystectomy symptoms. When selecting patients with biliary pain only in a randomized controlled trial, 30-40% still have persisting pain. Strategies for the selection of patients with symptomatic uncomplicated gallstones based on symptoms alone are exhausted. For the development of a selection strategy, future studies should explore the impact of objective determinants for symptomatic gallstones on pain relief following cholecystectomy.

Acute Cholecystitis Masking a Gastric Bezoar

A bezoar is a solid mass of indigestible material that usually forms in the gastrointestinal (GI) tract. Gastric bezoars, located in the stomach, can present variably. They can be asymptomatic or present with GI symptoms like nausea, vomiting, abdominal pain, or more serious complications, such as GI obstruction or perforation. Diagnostic modalities are mainly radiological, and treatment may either be conservative or interventional. Herein, we disclose the case of a 47-year-old female who presented with a two-week history of abdominal pain with an incidental finding of a possible gastric phytobezoar, co-existing with gallbladder disease. Although not previously reported, this study highlights the possibility of an association between gallbladder disease and the formation of a bezoar.

Cholecystectomy and clinical presentations of gastroparesis

BACKGROUND

Many patients with gastroparesis have had their gallbladders removed.

AIM

To determine if clinical presentations of patients with gastroparesis differ in those with prior cholecystectomy compared to patients who have not had their gallbladder removed.

METHODS

Gastroparetic patients were prospectively enrolled in the NIDDK Gastroparesis Registry. Detailed history and physical examinations were performed; patients filled out questionnaires including patient assessment of GI symptoms.

RESULTS

Of 391 subjects with diabetic or idiopathic gastroparesis (IG), 142 (36 %) had a prior cholecystectomy at the time of enrollment. Patients with prior cholecystectomy were more often female, older, married, and overweight or obese. Cholecystectomy had been performed in 27/59 (46 %) of T2DM compared to 19/78 (24 %) T1DM and 96/254 IG (38 %) (p = 0.03). Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization, and had a worse quality of life. Independent characteristics associated with prior cholecystectomy included insidious onset (OR = 2.06; p = 0.01), more comorbidities (OR = 1.26; p < 0.001), less severe gastric retention (OR(severe) = 0.68; overall p = 0.03) and more severe symptoms of retching (OR = 1.19; p = 0.02) and upper abdominal pain (OR = 1.21; p = 0.02), less severe constipation symptoms (OR = 0.84; p = 0.02), and not classified as having irritable bowel syndrome (OR = 0.51; p = 0.02). Etiology was not independently associated with a prior cholecystectomy.

CONCLUSIONS

Symptom profiles in patients with and without cholecystectomy differ: postcholecystectomy gastroparesis patients had more severe upper abdominal pain and retching and less severe constipation. These data suggest that prior cholecystectomy is associated with selected manifestations of gastroparesis.

Influence of portal-azygos devascularization via abdomen with stapler on gastric motility in portal hypertension canines with liver cirrhosis

AIM: To investigate influence of portal-azygos devascularization via abdomen with stapler on gastric motility in portal hypertension canines with liver cirrhosis and the significance of pyloroplasty.

METHODS: Eighteen portal hypertension canines with liver cirrhosis were randomly divided into three groups. Portal-azygos devascularization via abdomen with stapler was performed in group A, while portal-azygos devascularization via abdomen with stapler and pyloroplasty were performed in group B. Sham operation was performed in group C, the control group. The changes of gastric motility in all canines were studied using real-time ultrasonography.

RESULTS: In group A, gastric emptying half-time and emptying time were delayed, gastric peristalsis frequency, amplitude and motility indices were reduced at day 7 post-operation compared with pre-operation (101.8 ± 16.89 min vs 63.22 ± 12.67 min, 215.0 ± 31.26 min vs 153.7 ± 22.45 min, 0.96 ± 0.21 vs 2.11 ± 0.55, 0.12 ± 0.03 vs 0.20 ± 0.04, 0.17 ± 0.05 vs 0.47 ± 0.13, all P < 0.05). Fourteen days after operation, all other indices except for gastric peristalsis frequency returned to the pre-operation levels (P > 0.05). At day 21 post-operation, there was no significant difference in gastric peristalsis frequency compared with pre-operation (P > 0.05). In group B, gastric emptying half-time and emptying time at day 7 post-operation returned to the pre-operation levels (P > 0.05), but gastric peristalsis frequency was reduced (0.91 ± 0.38 vs 2.04 ± 0.49, P < 0.05). At day 21 post-operation, there was no significant difference in gastric peristalsis frequency compared with pre-operation. All indices returned to the pre-operation levels in group C at day 7 post-operation.

CONCLUSION: Pyloroplasty improves gastric emptying only in 7 days after portal-azygos devascularization via abdomen with stapler. It is unnecessary to add pyloroplasty regularly in portal-azygos devascularization via abdomen with stapler.