Cholecystectomy and clinical presentations of gastroparesis.

Abstract

BACKGROUND:

Many patients with gastroparesis have had their gallbladders removed.

AIM:

To determine if clinical presentations of patients with gastroparesis differ in those with prior cholecystectomy compared to patients who have not had their gallbladder removed.

METHODS:

Gastroparetic patients were prospectively enrolled in the NIDDK Gastroparesis Registry. Detailed history and physical examinations were performed; patients filled out questionnaires including patient assessment of GI symptoms.

RESULTS:

Of 391 subjects with diabetic or idiopathic gastroparesis (IG), 142 (36 %) had a prior cholecystectomy at the time of enrollment. Patients with prior cholecystectomy were more often female, older, married, and overweight or obese. Cholecystectomy had been performed in 27/59 (46 %) of T2DM compared to 19/78 (24 %) T1DM and 96/254 IG (38 %) (p = 0.03). Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization, and had a worse quality of life. Independent characteristics associated with prior cholecystectomy included insidious onset (OR = 2.06; p = 0.01), more comorbidities (OR = 1.26; p < 0.001), less severe gastric retention (OR(severe) = 0.68; overall p = 0.03) and more severe symptoms of retching (OR = 1.19; p = 0.02) and upper abdominal pain (OR = 1.21; p = 0.02), less severe constipation symptoms (OR = 0.84; p = 0.02), and not classified as having irritable bowel syndrome (OR = 0.51; p = 0.02). Etiology was not independently associated with a prior cholecystectomy.

CONCLUSIONS:

Symptom profiles in patients with and without cholecystectomy differ: postcholecystectomy gastroparesis patients had more severe upper abdominal pain and retching and less severe constipation. These data suggest that prior cholecystectomy is associated with selected manifestations of gastroparesis.

• Authors: Henry P Parkman, Katherine Yates, William L Hasler, Linda Nguyen, Pankaj J Pasricha, William J Snape, Gianrico Farrugia, Kenneth L Koch, Jorge Calles, Thomas L Abell, Irene Sarosiek, Richard W McCallum, Linda Lee, Aynur Unalp-Arida, James Tonascia, Frank Hamilton
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 58 Issue 4 Pg. 1062-73 (Apr 2013) ISSN: 1573-2568 [Electronic] United States
• PMID: 23456496 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Antiemetics
• Narcotics

Topics

• Adult
• Antiemetics (therapeutic use)
• Cholecystectomy
• Female
• Gastric Emptying
• Gastroparesis (drug therapy, epidemiology, etiology)
• Humans
• Logistic Models
• Male
• Middle Aged
• Narcotics (therapeutic use)
• Postoperative Complications (drug therapy, epidemiology, etiology)
• Prospective Studies
• United States (epidemiology)