Increased Duodeno-Gastro-Esophageal Reflux (DGER) in Symptomatic GERD Patients with a History of Cholecystectomy

Abstract

Zusammenfassung ! Grundlagen: Der duodeno-gastro-ösophageale Reflux (DGER) wird als unabhängiger Risikofaktor für die Entstehung einer komplizierten gastro-öso-phagealen Refluxerkrankung (GERD) angesehen. Sowohl klinische als auch epidemiologische Daten lassen vermuten, dass eine Cholezystektomie (CCE) das Ausmaß eines DGER beeinflussen könnte. Methoden: 132 Patienten (67 Frauen, 65 Männer, Altersmedian 55) mit typischen klinischen Beschwerden einer GERD wurden in die Studie eingeschlossen. Die Patienten wurden unterteilt in cholezystektomiert (CCE-Gruppe, n = 25) und nicht cholezystektomiert (nCCE-Gruppe, n = 107). Die standardisiert durchgeführte Diagnostik beinhaltete eine 24-h-pH-Metrie mit Bilitec 2000 und Ösophagusmanometrie sowie eine Ösophago-gastro-Duodenoskopie. Ergebnisse: Die statistische Analyse erbrachte keine signifikanten Unterschiede weder in Quantität noch Qualität von Refluxsymptomen zwischen den Patienten mit und ohne Cholezystektomie. Weitergehend unterschied sich die CCE-Gruppe weder in dem Ausmaß des sauren Refluxes noch in dem Auftreten oder der Schwere einer Refluxösophagitis von der nCCE-Gruppe. Jedoch wies die CCE-Gruppe einen signifikant höheren Prozentsatz von Patienten mit einem pathologisch gesteigerten DGER im Vergleich zu der nCCE-Gruppe auf (76 vs. 55%, p < 0,01). Entsprechend zeichnete sich die CCE-Gruppe durch einen signifikant höheren DGERD im Vergleich zu der nCCE-Gruppe aus (15,5% ± 14,1 vs. 8,6% ± 15,4; p < 0,05). Schlussfolgerung: In der hier vorgestellten Studie konnte erstmals der potenzielle Einfluss einer Cholezystektomie auf das Ausmaß des DGER in Patienten mit klinischen Symptomen einer Refluxerkrankung unter Verwendung des Bilitec 2000 gezeigt werden. Sowohl die Frequenz als auch das Ausmaß des DGER waren in der CCEAbstract ! Backgrounds: Duodenal-Gastro-Esophageal Reflux (DGER) represents an independent risk factor for the development of complicated Gastro-esophageal-reflux-disease (GERD) and Barrett's esophagus. Clinical and epidemiological data suggest a potential association between cholecystectomy (CCE) and augmented bile reflux. Methods: 132 patients (67 women, 65 men, median age 55) with typical symptoms of GERD were enrolled in the study and divided in cholecystectomized (CCE-group: n = 107) and noncholecystectomized (nCCE-group: n = 25) patients. Standardized clinical work-up of patients included combined esophageal 24 h pH-measurement and Bilitec 2000 esophageal manometry and upper endoscopy. Results: In the statistical analysis no differences between the cholecystectomized group (CCEgroup, n = 25) and the patients without cholecystectomy (nCCE-group, n = 107) could be observed in quantity or quality of reflux symptoms. Furthermore, neither acid reflux nor severity of inflammation and frequency of Barrett's esophagus significantly differed between the nCCE and CCEgroup. However, the percentage of patients with pathological DGER were significantly higher in the CCE-group as compared to the nCCE-group (76 vs. 55%, p < 0.01). Moreover, the CCE-group revealed ...

Cholecystectomy and the risk of alimentary tract cancers: A systematic review

“…The increased and continuous bile flow into the duodenum can either reflux back into the stomach and oesophagus or proceed cephalad down to the small and large bowel. Increased duodenogastro-oesophageal reflux after cholecystectomy is controversial [74][75][76] and probably relates to the method of measurement [76] . The effects of refluxed bile may be augmented by additional noxious refluxed material such as acid and pancreatic enzymes [77] .…”

“…Six studies (4 case-control; 2 cohort) demonstrated a positive association between proximal colon cancer and cholecystectomy [59,62,63,[67][68][69][70][71][72][73][74][75][76][77][78][79] . An extremely high association (OR = 5.85, 95%CI: 2.13-16.7) was found in one particular Chinese study but 95%CIs were broad and a low quality assessment score indicates these findings are somewhat unreliable [62] .…”

Evaluation of gastroesophageal reflux after laparoscopic cholecystectomy using combined impedance-pH monitoring

“…20 Studies have shown that esophageal reflux is more common in cholecystectomy patients than in control population and it is suggested that duodeno-gastric reflux may play a significant role in the pathogenesis of PCS. 4,15,21 However, other studies shows contrary results. Lin et al compared pre-and postcholecystectomy changes in reflux symptoms in a large controlled prospective observational study.…”

“…4,5 However, there are also studies, which shows no change. 6,7 In 1991, Silny was the first investigator who described multichannel intra-luminal impedance (MII), a technique which detects intra-esophageal bolus transport by measuring the resistance to alternating current (i.e., impedance) of the content of the esophageal lumen.…”

Cholecystectomy and risk of laryngeal and pharyngeal cancer

“…Since confounding cannot be ruled out as an explanation for the association between gastrectomy and laryngeal or pharyngeal cancer, it is valuable to address exposure to bile reflux in relation to these tumors also using other approaches. Cholecystectomy for gallstones offers such possibility, since it is followed by an increased level of bile in the gastric juice due to a continuous flow of bile to the duodenum, and patients with reflux who have undergone cholecystectomy have an increased bile acid presence in the esophagus 8. Moreover, cholecystectomized patients have an increased risk of developing esophageal adenocarcinoma, which may be explained by bile salts 9, 10.…”