Is laparoscopic cholecystectomy effective in relieving dyspepsia in patients of cholelithiasis? A prospective study

Abstract

Background: Laparoscopic cholecystectomy (LC) is routinely done for symptomatic gallstone disease; however, its role in relieving dyspeptic symptoms in cholelithiasis is controversial. Aim: The study was designed to assess the role of laparoscopic cholecystectomy in relieving dyspeptic symptoms in patients having cholelithiasis with only dyspeptic symptoms. Methods: Patients with cholelithiasis having only dyspeptic symptoms not attributable to other causes (like Helicobacter pylori) were subjected to laparoscopic cholecystectomy. Dyspepsia scores (Dyspepsia Severity Assessment Score-DSAS and Gastrointestinal Quality of Life Index-GIQLI) were measured before and after surgery and analyzed using Greenhouse-Geisser, McNemar's and ANOVA tests. Results: 27 patients (M:F=1:26, mean age=40.48±10.60 years) having dyspepsia with asymptomatic gallstones were included in the study. There was significant improvement in DSAS (20.11±4.36 vs 28.63±3.42; p<0.001) and GIQLI(106.11±5.77 vs 122.56±7.95; p<0.001) after 2 months of LC. All symptoms improved individually; relief in early satiety and vomiting was the maximum (outcome benefit ratios=0.954, p=0.007 and 0.937, p=0.005 respectively). Multiple gallstones caused more dyspepsia than single (p=0.005). There was no significant difference between H. pylori positive and negative groups in terms of improvement of DSAS and GIQLI scores after LC (p=0.897 and p=0.375 respectively; however dyspepsia was seen to improve significantly within both groups). Conclusion: Dyspepsia may be a symptom of gallstone disease, and these patients can benefit from LC especially when early satiety and vomiting are the main symptoms. A larger sample size may offer more insight.

Fate of Dyspeptic Symptoms Following Lap. Cholecystectomy.

“…43,44 Manas et al showed (18.5%) symptoms persistence with majority of epigastric pain (11.1%). 47 The majority of patients with persistent symptoms in our study have dyspeptic symptoms (62%), which is the same result of both MC Metens et al and Manas et al (57.3%) this may be due to dyspepsia, being the most common presenting clinical symptom in most of the upper G.I. problems.…”

“…The same was seen in Konsten et al; while velpen et al study revealed a different percentage for those with symptoms persistence as it was only 5%. [47][48][49] According to pre-operative assessment our study shows that the highest percentage of patient had pain sited at the Rt. upper quadrant of the abdomen (56.5%) and the majority described radiation to Rt.…”

Fate of dyspeptic symptoms following Lap. cholecystectomy

“…Manas et al also showed female predominance as (96%) and symptoms persist in (18.5%) and the majority of them were females. The same was seen in Konsten et al; while velpen et al study revealed a different percentage for those with symptoms persistence as it was only 5% [47,49] . According to pre-operative assessment our study shows that the highest percentage of patient had pain sited at the Rt.…”

“…This can be explained by the later discovery that the major cause in persistent symptoms was due to causes related to an upper abdominal pathology ( GERD, PU….etc.) [43,44] Manas et al showed (18.5%) symptoms persistence with majority of epigastric pain (11.1%) [47] . The majority of patients with persistent symptoms in our study have dyspeptic symptoms (62%), which is the same result of both MC Metens et al and Manas et al (57.3%) this may be due to dyspepsia, being the most common presenting clinical symptom in most of the upper G.I.…”

Nyeri Epigastrik sebagai Presentasi Awal Kolelitiasis

“…Gejala penyerta dapat berupa mual, muntah, rasa kembung, bersendawa, dan heartburn. 3,4 Sindrom dispepsia dapat disebabkan oleh berbagai hal, meliputi ulkus peptikum, penyakit refluks gastro-esofageal, hernia hiatus, dan dispepsia fungsional (sindrom dispepsia tanpa kelainan organik, sistemik, dan metabolik yang dapat menjelaskan penyebab keluhan tersebut). 3 Persamaan gejala antara dispepsia fungsional dan kolelitiasis simtomatik dapat menyebabkan kesalahan diagnosis.…”