Abstract
BackgroundCholecystectomy, gold standard treatment for gallbladder lithiasis, is closely associated with increased bile reflux into the stomach as amply demonstrated by experimental studies. The high prevalence of gallstones in the population and the consequent widespread use of surgical removal of the gallbladder require an assessment of the relationship between cholecystectomy and gastric mucosal disorders.Morphological evaluations performed on serial pre and post – surgical biopsies have provided new acquisitions about gastric damage induced by bile in the organ.Methods62 elderly patients with gallstone related disease were recruited in a 30 months period. All patients were subjected to the most appropriate treatment (Laparoscopic cholecystectomy). The subjects had a pre-surgical evaluation with:• dyspeptic symptoms questionnaire,• gastric endoscopy with body, antrum, and fundus random biopsies,• histo-pathological analysis of samples and elaboration of bile reflux index (BRI).The same evaluation was repeated at a 6 months follow-up.ResultsIn our series the duodeno-gastric reflux and the consensual biliary gastritis, assessed histologically with the BRI, was found in 58% of the patients after 6 months from cholecystectomy. The demonstrated bile reflux had no effect on H. pylori’s gastric colonization nor on the induction of gastric precancerous lesions.ConclusionsCholecystectomy, gold standard treatment for gallstone-related diseases, is practiced in a high percentage of patients with this condition. Such procedure, considered by many harmless, was, in our study, associated with a significant risk of developing biliary gastritis after 6 months during the postoperative period.
Highlights
Cholecystectomy, gold standard treatment for gallbladder lithiasis, is closely associated with increased bile reflux into the stomach as amply demonstrated by experimental studies
We decided to perform a prospective study on elderly patients which refer to our general surgery department in order to evaluate whether cholecystectomy increases the risk of gastritis, induces the onset of dyspeptic symptoms, alters the incidence of H. pylori infection or increases the risk of gastric cancer
The primary objective of our study was to evaluate the incidence of postoperative biliary gastritis through the prospective evaluation of patients with symptomatic gallbladder lithiasis treated with laparoscopic cholecystectomy
Summary
Cholecystectomy, gold standard treatment for gallbladder lithiasis, is closely associated with increased bile reflux into the stomach as amply demonstrated by experimental studies. Numerous studies have shown an association between cholecystectomy and gastric cancer [8-12]; the increased bile reflux may be a determining factor, if this risk was confirmed. It is common, in patients who undergo cholecystectomy, to observe a persistence of upper abdominal symptoms often labeled as post-cholecystectomy syndrome [3,13-17]; these symptoms are likely related to a post-surgical duodenal-gastric reflux. We decided to perform a prospective study on elderly patients which refer to our general surgery department in order to evaluate whether cholecystectomy increases the risk of gastritis, induces the onset of dyspeptic symptoms, alters the incidence of H. pylori infection or increases the risk of gastric cancer
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