A systematic review of the aetiology and management of post cholecystectomy syndrome

Isherwood, Jennifer; Oakland, Kathryn; Khanna, Arun

doi:10.1016/j.surge.2018.04.001

Cited by 42 publications

(35 citation statements)

References 33 publications

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“…Findings include a wide panel of gastric disorders such as peptic ulcer, hiatus hernia and gastro‐oesophageal reflux. Misdiagnosis of some pre‐existing diseases, however, is possible …”

Section: Discussionmentioning

confidence: 99%

“…Nonspecific gastrointestinal symptoms can also appear in about 10% of patients after cholecystectomy, but the origin of these disturbances is still unclear . The aim of this study was therefore to evaluate the coexistence of motor disorders of the gastrointestinal tract along with dyspeptic symptoms, in patients with a gallbladder “in situ” and in a group of matched patients after a cholecystectomy.…”

Section: Introductionmentioning

confidence: 99%

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Gastrointestinal defects in gallstone and cholecystectomized patients

Ciaula

Molina-Molina

Bonfrate

et al. 2019

Eur J Clin Investigation

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Background and aim Several gallstone patients complain of dyspeptic symptoms, irrespective of the presence of typical colicky pain. Symptoms often persist after a cholecystectomy. Systematic studies on dyspepsia and dynamic gastrointestinal motor function are missing in gallstone patients with preserved gallbladder or after a cholecystectomy. Materials and methods Forty‐six gallstone patients (age 55 ± 2 years; 15M, 31F) and 24 cholecystectomized patients (age 57 ± 2 years; 6M, 18F) (no difference in type and volume of gallstones between the two groups) were compared against a group of 65 healthy controls (age 51 ± 2 years; 30M, 35F). Dyspepsia occurring in the prior months was assessed by a questionnaire, gastric and gallbladder emptying by functional ultrasonography and orocecal transit time by a hydrogen breath test using a lactulose‐enriched standard liquid meal. Results Gallstone patients had significantly greater dyspepsia, fasting and residual gallbladder volumes, and slower gallbladder emptying, gastric emptying and small intestinal transit time than controls. In cholecystectomized patients, gastric emptying further delayed, compared to gallstone patients and controls. Conclusion Gallstone patients with the gallbladder “in situ” or after a cholecystectomy display dyspeptic symptoms. Symptoms are associated with multiple gastrointestinal motility defects involving the gallbladder, stomach and small intestine. After cholecystectomy, gastric emptying worsens.

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“…Findings include a wide panel of gastric disorders such as peptic ulcer, hiatus hernia and gastro‐oesophageal reflux. Misdiagnosis of some pre‐existing diseases, however, is possible …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gastrointestinal defects in gallstone and cholecystectomized patients

Ciaula

Molina-Molina

Bonfrate

et al. 2019

Eur J Clin Investigation

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“…Это не в последнюю очередь связано с высокой частотой выполнения ХЭ -2,5 млн вмешательств в мире ежегодно (!). Следует учитывать, что 2/3 всех случаев функциональной патологии желчевыводящих путей сочетаются с заболеваниями пищеварительного тракта, в первую очередь функциональной природы [3,5,6]. По данным литературы, у 20-40% пациентов, перенесших ХЭ, сохраняются жалобы на билиарную боль.…”

Section: эпидемиологияunclassified

“…По данным разных источников, от 5 до 50% больных, перенесших холецистэктомию (ХЭ), продолжают предъявлять жалобы, аналогичные таковым до операции или изменившиеся по характеру и интенсивности [1][2][3][4][5]. Многим из них, особенно в России и в странах, входивших в состав СССР, автоматически устанавливается диагноз «постхолецистэктомический синдром» без детального анализа обусловливающих его причин.…”

Section: Introductionunclassified

Sphincter of Oddi dysfunction in the post-cholecystectomy period

Буеверов

2020

Medicinskij sovet

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The persistent post-cholecystectomy (CE) symptoms can be divided into four groups: 1) surgical errors; 2) recurrence of cholelithiasis; 3) functional disorders due to removal of the gallbladder (transient or persistent); 4) pathology not associated with CE. Biliary pain persists in 20–40% of patients after CE, in most cases caused by sphincter of Oddi dysfunction (SOD). SOD is subdivided into biliary, pancreatic, two-duct types, as well as pancreatobiliary reflux. The SOD is rooted in the increased pressure in the sphincter, which leads to the increased intraductal pressure and, as a result, to the occurrence of biliary or pancreatic pain. In addition, the direct contractile effects of cholecystokinin on smooth muscles of the biliary tract change due to mechanical disturbance of innervation. Hypertension of the pancreatic part of the sphincter of Oddi can cause not only the occurrence of functional pain of the pancreatic type, but also the development of recurrent pancreatitis. SOD is characterized by typical anamnestic data that are common to the functional pathology of the digestive system, such as duration of symptoms, absence of organic pathology, multiple complaints, a non-progressive course, the provoking role of psychoemotional factors. From a practical standpoint, the clinical criteria for SOD can be: 1) an attack of biliary or pancreatic pain; 2) a transient increase in the activity of hepatic or pancreatic enzymes; 3) transient expansion of the common bile or major pancreatic duct. If it is difficult to differentiate diagnosis, endoscopic ultrasonography is advisable. Antispasmodics and ursodeoxycholic acid form the basis of the treatment, especially when biliary sludge and microlithiasis are detected. There must be strong arguments for the surgical treatment.

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“…In these cases, however, a misdiagnosis of pre-existing clinical conditions is possible. In a longer time window, the most common cause is the presence of stones within the biliary tree 173 .…”

Section: Future Perspectives: From Therapy To Preventionmentioning

confidence: 99%

Recent advances in understanding and managing cholesterol gallstones

Ciaula

Portincasa

2018

F1000Res

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The high prevalence of cholesterol gallstones, the availability of new information about pathogenesis, and the relevant health costs due to the management of cholelithiasis in both children and adults contribute to a growing interest in this disease. From an epidemiologic point of view, the risk of gallstones has been associated with higher risk of incident ischemic heart disease, total mortality, and disease-specific mortality (including cancer) independently from the presence of traditional risk factors such as body weight, lifestyle, diabetes, and dyslipidemia. This evidence points to the existence of complex pathogenic pathways linking the occurrence of gallstones to altered systemic homeostasis involving multiple organs and dynamics. In fact, the formation of gallstones is secondary to local factors strictly dependent on the gallbladder (that is, impaired smooth muscle function, wall inflammation, and intraluminal mucin accumulation) and bile (that is, supersaturation in cholesterol and precipitation of solid crystals) but also to “extra-gallbladder” features such as gene polymorphism, epigenetic factors, expression and activity of nuclear receptors, hormonal factors (in particular, insulin resistance), multi-level alterations in cholesterol metabolism, altered intestinal motility, and variations in gut microbiota. Of note, the majority of these factors are potentially manageable. Thus, cholelithiasis appears as the expression of systemic unbalances that, besides the classic therapeutic approaches to patients with clinical evidence of symptomatic disease or complications (surgery and, in a small subgroup of subjects, oral litholysis with bile acids), could be managed with tools oriented to primary prevention (changes in diet and lifestyle and pharmacologic prevention in subgroups at high risk), and there could be relevant implications in reducing both prevalence and health costs.

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A systematic review of the aetiology and management of post cholecystectomy syndrome

Cited by 42 publications

References 33 publications

Gastrointestinal defects in gallstone and cholecystectomized patients

Gastrointestinal defects in gallstone and cholecystectomized patients

Sphincter of Oddi dysfunction in the post-cholecystectomy period

Recent advances in understanding and managing cholesterol gallstones

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