Gastric Emptying in Patients With Gallstone Disease With or Without Dyspepsia: Effect of Cholecystectomy

Abstract

Dyspepsia is a common complaint in patients presenting with gallstone disease. Since the stomach appears to be its site of origin, the present study was undertaken to assess gastric emptying in patients with gallstone disease and to find out its correlation with dyspeptic symptoms before and after cholecystectomy. Gastric emptying (t1/2) was prospectively assessed in 43 patients with symptomatic gallstones (29 with and 14 without dyspepsia). These data were compared with that of 20 healthy volunteers (control group). Delayed gastric emptying (> 112 min: mean + 2 s.d. of the control group) was observed in 18 patients (42%; P < 0.002), 10 of whom presented with dyspepsia and eight without (NS). Re‐evaluation in 18 of the 29 patients with dyspepsia, 3 months after cholecystectomy, revealed complete disappearance of symptoms in three, improvement in 11 and no change in four patients. After 6 months, two patients had reverted back to their pre‐operative dyspeptic status; resulting in three patients completely cured, nine partially cured and six without any change in their dyspeptic status at this time. Gastric emptying was delayed in nine of the 18 patients before cholecystectomy. After cholecystectomy, normal emptying was observed in all but one patient (P < 0.005). Dyspeptic symptoms, however, completely disappeared in one patient, improved in five and remained unchanged in three. In the remaining nine patients, gastric emptying was normal both before and after cholecystectomy. Gallstone disease is associated with delayed gastric emptying but this delay was not the cause of dyspepsia in these patients. Cholecystectomy normalizes gastric emptying, a finding that has not been reported previously. However, on the basis of gastric emptying alone, it is not possible to predict the outcome of cholecystectomy.

Gastrointestinal defects in gallstone and cholecystectomized patients

“…Dyspeptic symptoms might rather originate from multiple coexisting motility defects in gallstone patients, likely persisting after a cholecystectomy. This is the case in this study and in another study, which examined gallstone patients before and after a cholecystectomy . Indeed, dyspepsia persisted in a consistent number of patients.…”

“…The extent and timing of gastric emptying worsen after gallbladder removal, pointing to the presence of altered pathways involving bile flow and/or signalling molecules. At variance with the present study, an early report found improved gastric emptying following cholecystectomy . Differences in selection and number of patients, characteristics of study design (ie two separate groups in this study vs pre‐postcholecystectomy in the study by Ibrarullah) and duration of follow‐up might account for such differences.…”

“…At variance with the present study, an early report found improved gastric emptying following cholecystectomy. 40 Differences in selection and number of patients, characteristics of study design (ie two separate groups in this study vs pre-postcholecystectomy in the study by Ibrarullah 40 ) and duration of follow-up might account for such differences.…”

“…This is the case in this study and in another study, which examined gallstone patients before and after a cholecystectomy. 40 Indeed, dyspepsia persisted in a consistent number of patients. Indirectly, we confirm that the colicky pain is a specific symptom clinically linked to the presence of uncomplicated gallstones, and it should be considered in a group of patients who are scheduled for a cholecystectomy.…”

Abdominal symptoms: do they disappear after cholecystectomy?

“…Seven additional publications were identified from the reference lists. Of these 34 publications 11 articles had to be excluded: in 5 the presentation of the results precluded a comparison between pre-and postoperative symptoms [5,22,27,36,39]; in 3 the subject of the article was not related to the subject under study [12,26,35]; in 1 follow-up was restricted to patients with postoperative symptoms only [16]; and the data of 2 studies had already been presented in another included study [2,18]. Thus, 23 articles were available for the analysis.…”