The postcholecystectomy syndrome. A role for duodenogastric reflux

We have assessed the relationship between dyspepsia and gallstones and evaluated the effects of cholecystectomy on symptoms, endoscopic findings, and degree of duodenogastric reflux. Thirty patients with gallstones were enrolled in our study. Their symptoms, gastroscopic findings, and bile salt concentrations in fasting gastric juice were evaluated before and after surgery. Before cholecystectomy, biliary colic was present in 26 patients and dyspepsia in 20 patients; 16 patients also had biliary colic. After surgery, biliary colic disappeared in all patients. Dyspeptic symptoms improved in 12 patients (40%), 13 (43%) remained the same, and five patients (17%) developed dyspepsia or showed increase in their symptoms, the postcholecystectomy syndrome (PCS). Endoscopic gastritis developed in 50% after surgery compared with 30% before. Benign gastric ulcers developed in three patients, whereas none had been present before. Concentration of bile salts in fasting gastric juice increased from 0.56 +/- 0.4 mM to 1.47 +/- 0.75 mM after cholecystectomy (p < 0.0001). There was a positive correlation between the severity of symptoms in the postcholecystectomy syndrome and the change in the concentration of bile salts in fasting gastric juice (p = 0.0012). These observations suggest that duodenogastric reflux may play a significant role in the pathogenesis of symptoms in the postcholecystectomy syndrome.