[The relationship between bile reflux and symptoms in patients with gallstones before and after cholecystectomy]

Many hypotheses affirm that postcholecystectomy syndrome is caused by alterations in bile flow due to the loss of the reservoir function of the gallbladder. We aimed to establish the relationship between postcholecystectomy symptoms and bile reflux.

Thirty patients with gallstones were included in the study. All patients underwent combined ambulatory pH and bile monitoring (Bilitec). Three months after cholecystectomy, the tests were repeated.

Before surgery, the median (interquartile range) total time pH < 4 was 2.8% (0.2-14%) and bilirubin absorbance > 0.14 was 4.1% (0-17%). After cholecystectomy, the median total time pH < 4 was 3.7% (1.5 %-11.4%) and bilirubin absorbance > 0 14 was 13.25% (5.30%-26.5%). The correlation between total time pH < 4 and total time bilirubin absorbance > 0.14 for all patients was good: r = 0.55, p < 0.001. Before surgery 65.03% of symptoms were not associated with neither acid nor bile reflux and postcholecystectomy 37.87% of symptoms were associated with bile reflux and 36.95% without any reflux. Cholecystectomy determines increased biliary reflux compared to the patients with gallstones. Related to gallstones, after cholecystectomy dyspeptic complains are more often related to bile reflux.

Although cholecystectomy itself does cause increased biliary reflux, in most patients with significant duodenogastric reflux symptoms were not correlated with biliary reflux.