Factors that predict relief from upper abdominal pain after cholecystectomy.

Abstract

BACKGROUND & AIMS:

Upper abdominal pain (UAP) in patients with gallstones is often treated by cholecystectomy but it frequently persists. We aimed to identify symptoms associated with relief.

METHODS:

We followed 1008 patients who received cholecystectomy for gallstones and UAP at the Mayo Clinic (Rochester, Minnesota) or Kaiser Permanente (San Diego, California) for 12 months. A validated, self-completed biliary symptoms questionnaire identified features of UAP, gastroesophageal reflux disease (GERD), and irritable bowel syndrome (IBS); the questionnaire was given initially and 3 and 12 months after cholecystectomy, to identify features that predicted sustained relief of UAP.

RESULTS:

Five hundred ninety-four patients (59%) reported relief from UAP. Factors associated univariately (P < .05) with relief included frequency of UAP ≤1 per month, onset ≤1 year preoperatively, usual duration (30 minutes to 24 hours, most often in the evening or night), and severity >5/10. Compared to no features, multiple predictive features of UAP (frequency, onset, duration, or timing) were associated with increasing odds ratios (95% confidence interval) for relief: 1, 2, or 3 features (4.2 [1.1-16]; P = .03) and 4 features (6.3 [1.6-25]; P = .008). Negative univariate associations included lower abdominal pain (LAP), usual bowel pattern, nausea ≥1 per week, often feeling bloated or burpy, GERD, and/or IBS. There was an inverse association between relief and somatization; relief was not associated with postprandial UAP. Multivariable logistic regression analysis revealed independent associations (P < .05) with UAP frequency, onset, and nocturnal awakening, but inverse associations with lower abdominal pain, abnormal bowel pattern, and frequent bloated or burpy feelings.

CONCLUSIONS:

UAP features and concomitant GERD, IBS, and somatization determine the odds for relief from UAP after cholecystectomy.

• Authors: Johnson L Thistle, George F Longstreth, Yvonne Romero, Amindra S Arora, Julie A Simonson, Nancy N Diehl, William S Harmsen, Alan R Zinsmeister
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 9 Issue 10 Pg. 891-6 (Oct 2011) ISSN: 1542-7714 [Electronic] United States
• PMID: 21699805 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

Topics

• Abdominal Pain (etiology)
• Adult
• Aged
• Biliary Tract Diseases (epidemiology)
• California
• Cholecystectomy
• Female
• Gallstones (complications, surgery)
• Gastroesophageal Reflux (epidemiology)
• Humans
• Irritable Bowel Syndrome (epidemiology)
• Male
• Middle Aged
• Minnesota
• Prognosis
• Risk Factors
• Surveys and Questionnaires