Abstract
Decreased gallbladder ejection fraction was reported in patients who had abdominal pain and gastrointestinal (GI) diseases. The study aims were to review the pathology of GI tract in children with acalculous biliary-type abdominal pain and to evaluate the pain improvement after a 2-week trial of proton pump inhibitor (PPI) and laparoscopic cholecystectomy (LC). Children younger than 18 years with a history of biliary-type abdominal pain by ROME III criteria were evaluated. All underwent an upper endoscopy, and their histologic findings of the proximal GI tract were reviewed. Responses to a 2-week trial of PPI and LC were analyzed. Sixteen were identified with biliary-type abdominal pain with gallbladder ejection fraction less than 35%. Endoscopic and histologic evidence of reflux esophagitis was observed in 11 children and gastritis in 3 children. A GI pathology of these children is mostly acid related, and 4 of 10 children experienced a complete response to PPIs and did not require LC. Nine children had LC; 4 had complete and 4 had partial pain improvement. A trial of PPIs may be cost-effective before considering LC in these patients because 4 of 10 children experienced a complete response to PPIs without the requirement of LC, compared with 4 of 9 children who improved completely.
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