EFFECT OF CHOLECYSTECTOMY ON DUODENOGASTRIC REFLUX, GASTRIC MUCOSA AND SERUM GASTRIN LEVEL

Abstract

Cholecystectomy is a common surgical procedure. Most patients show up to do cholecystectomy due to the dyspeptic symptoms accompanying chronic calcular cholecystitis. Some patients who underwent cholecystectomy may still have dyspeptic symptoms, which is annoying for them as they expect to improve dramatically following the procedure. Gastric mucosal changes related to duodcnogastric reflux arc accused for persistence of these dyspeptic symptoms post-cholecystectomy. In this study, we evaluated the rates of duodenogastric reflux, gastric mucosal changes and dyspeptic symptoms in cholecystectomized patients. Sixty patients were enrolled in the study; they were divided into two groups (gallstone and control group). Estimation of bile acid concentration in gastric juice and serum gastrin levels pre and 3 months postoperatively were done for both groups in evaluation of DGR. Gallstone group was further subjected to upper GJ endoscopy and antral biopsies were taken and examined histologically. 26.6% of gallstone patients. Were found to have dyspeptic symptoms post-cholecystectomy. There was no statistical significance in the serum gastrin levels pre and postoperatively and in comparison with the control group. Bile acid concentrations were higher in gallstone patients than in control group and there was statistical significance in bile acid concentrations pre and postoperatively in gallstone group. DGR was evident in 66.7% of gallstone patients preoperatively and increase to 85.7% postoperatively. Histological specimens have showed that 46.6% of our gallstone patients seemed to have chronic superficial gastritis preoperatively and this percentage increased to 60% postoperatively. We concluded that duodenogastric reflux is more frequent in gallstone patients than in healthy individuals and that its incidence and grade increase after cholecystectomy. DGR causes consequently a degree of chronic gastritis, which is directly related to its grade. This proves the definite role of DGR in the persistence of symptoms in some gallstone patients after cholecystectomy. In order to distinguish from the other causes of post-cholecystectomy syndrome, patients with dyspeptic symptoms in the follow-up after cholecystectomy should be evaluated by upper Gl endoscopy for DGR related gastric mucosal changes.