Gastroduodenal pathology in patients with asymptomatic gallbladder stones

Gallbladder stones are still a common pathology worldwide, and the number of patients diagnosed without any symptoms is increasing due to the use of ultrasound and imaging tools such as CT and MRI. The aim of this study was to identify gastroduodenal pathologies in patients with diagnosed asymptomatic gallbladder stones, since some cases of epigastric pain may have led to unnecessary cholecystectomies.

Gastroscopic investigations were performed in 33 patients diagnosed with asymptomatic gallbladder stones during a gallstone screening program in Chiang Mai, Thailand, and followed-up with yearly ultrasound examinations. The mean age of the patients was 56.6 years, and mean follow-up time was 2.3 years.

Our results showed that inflammatory-based gastroduodenal lesions in this group were common (15/33 patients, 45.4%). Lesions included gastric ulcers (1 patient, 3%), duodenal ulcers (5 patients, 15.1%), and gastroduodenal ulcers (2 patients, 6.1%). Almost all of the ulcers were in the healing or scarring stage. Inflammatory-based mucosal changes were also detected in these patients as follows: erosive gastritis (6 patients, 18.2%) and hemorrhagic gastritis (1 patient, 3%).

Inflammatory-based gastroduodenal pathologies such as peptic ulcers and gastritis are common in patients with asymptomatic gallstones. If such patients become symptomatic, meticulous examinations are needed to avoid unnecessary cholecystectomies and resulting complications such as postcholecystectomy syndrome. The theory that gastroduodenal lesions occur after gallbladder removal needs to be re-evaluated given that lesions can be detected before surgery and even before the occurrence of symptoms.