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.