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Abdominal symptoms: do they predict gallstones? A systematic review
M Y Berger1, J J van der Velden, J G Lijmer
1Dept. of General Practice, Erasmus University, Rotterdam, The Netherlands.
Scandinavian Journal of Gastroenterology
|February 15, 2000
Summary
Biliary colic is specific for gallstones, but most patients present with other symptoms. Single abdominal symptoms, except biliary colic, lack diagnostic evidence for gallstones.
Area of Science:
- Gastroenterology
- Diagnostic Accuracy
- Medical Diagnostics
Background:
- Evaluating the diagnostic accuracy of abdominal symptoms for gallstones.
- Assessing variability in diagnostic accuracy based on study design and patient selection.
Purpose of the Study:
- To determine the diagnostic accuracy of abdominal symptoms in identifying gallstones.
- To analyze factors influencing diagnostic accuracy, such as clinical setting and disease extent.
Main Methods:
- Conducted a Medline search (1966-1998) and reference checking.
- Included 24 controlled studies with patients aged 18 years or older.
- Evaluated seven abdominal symptoms using logistic regression to analyze diagnostic accuracy modifiers.
Main Results:
- 'Biliary colic', 'radiating pain', and 'analgesics used' were consistently linked to gallstones.
- Study setting significantly impacted diagnostic accuracy; however, pooled diagnostic odds ratios were low.
- The diagnostic odds ratio for biliary colic increased with gallstone disease extent.
Conclusions:
- Biliary colic is specific, but 80% of gallstone patients exhibit other abdominal symptoms.
- Currently, no single abdominal symptom, other than biliary colic, is justified for diagnosing symptomatic gallstones.
- Future research should investigate the prognosis of patients with non-specific abdominal symptoms and gallstones.