Duodenogastric reflux and symptomatology before and after cholecystectomy in patients with symptomatic gall stone disease

ABSTRACT

The aim of this work was to address possible factors that initiate, maintain or worsen the symptoms of duodenogastric bile reflux in patients with gallstones and to evaluate the effect of surgical removal of the gall bladder on the duodenogastric reflux. The study was carried out on 30 female patients with symptomatic gallstone disease who were admitted to Medical Research Institute Hospital for elective cholecystectomy. Preoperative upper GIT endoscopy revealed presence of duodenogastric bile reflux in 70%, gastritis in 53.3% and duodenitis in 46.7%. The mean value of the body mass index [27.69 +/- 3.04] was in the overweight range. patients were parous and high multoparity was associated more with complications[obstructive jaundice and acute cholecystitis] with a strong association between multiparity and duodenogastric bile refulex. Positive family history of gallstone diseasee was associated more with symptoms purely retated to gallstones. Follow up by clinical assessment and endoscopy after 6 months revealed persistence of duodenogastric bile reflux in 76.7%, gastritis in 56.7% and duodenitis in 53.3% with a significant increase in the occrrence of both epigastric and right upper quadrant pain as the main symptom post operatively in 18 patients [60%] compared to 12 patients [40%] preoperatively. We concluded that duodenogastric bile reflux is responsible for the initiation of most of the gallbladder symptoms and most of those symptoms may persist or appear post operatively