ABSTRACT
Although cholecystectomy is one of the most frequently and successfully performed operation for treatment of symptomatic gall stones, the development of postoperative symptoms is embrassing to the surgeon and may represent a source of discomfort to the patient. The aim of this study is to evaluate the possible etiological factors that may be implicated in development of postcholecystectomy dyspepsia, including helicobacter pylori [H. pylori] colonization, gastric electrical and mucosal changes. This prospective study has been carried out on 46 patients [20 males and 26 females] with mean age of 41.7 +/- 0.2 years. All patients had symptomatic gall stones and were subjected to cholecystectomy. These patients were carefully evaluated before surgery and one year after. The workup included thourough history and clinical examination, upper gastrointestinal endoscopy, histopathological examination of the antral mucosa, H. pylori detection and electrogastrography [EGG]. The number of patients presenting with symptoms suggestive of reflux gastritis increased after surgery. Patients experiencing epigastric pain increased from 17.4% [8 cases] to 23.4% [11 cases], nausea increased from 13% [6 cases] to 26.1% [12 cases] and bilious vomiting increased from 6.5% [3 cases] to 23.9% [11 cases]. Mild antral gastritis increased from 43.5% [20 cases] to 58.7% [27 cases]. Moderate antral gastritis were detected in 17.4% [8 cases], whereas severe antral gastritis with erosions were detected only in 4.3% [2 patients] after cholecystectomy. The incidence of chronic superficial gastritis decreased from 50% to 28.2% while the inactive form increased from 32.6% to 50%. Chronic atrophic gastritis with intestinal metaplasia or dysplasia were only detected in 4.3% of patients. H. pylori infection decreased from 69.6% to 41.3% of patients. EGG abnormal frequencies decreased from 26.1% to 8.7% in the fasting state and form 16.9% to 4.3% in the postprandial state. The number of patients with decreased EGG amplitude after meal increased from 4.3% to 28.3%. Postcholecystectomy dyspepsia is considered one of the controversial issues as regard both the etiology and management. In this study we found that duodenogastric reflux [DGR] is significantly increased after cholecystectomy, whereas H. pylori colonization is considerably decreased. If reflux gastritis should conclusively be shown to cause dyspepsia, then these observations and findings would be helpful in management of residual or new dyspepeptic manifestations after cholecystectomy. Finally EGG may be used as an objective mean for detection and evaluation of these postoperative changes