Functional Dyspepsia and Irritable Bowel Syndrome are Highly Prevalent in Patients With Gallstones and are Negatively Associated With Outcomes After Cholecystectomy
Annals of Surgery
To determine the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS) in patients eligible for cholecystectomy and to investigate the association between presence of FD/IBS and resolution of biliary colic and a pain-free state. More than 30% of patients with symptomatic cholecystolithiasis reports persisting pain post-cholecystectomy. Co-existence of FD/IBS may contribute to this unsatisfactory outcome. We conducted a multicentre, prospective, observational study
... nal study (PERFECT-trial). Patients ≥18 years with abdominal pain and gallstones were included at five surgical outpatient clinics between 01/2018-04/2019. Follow-up was six months. Primary outcomes were prevalence of FD/IBS, and the difference between resolution of biliary colic and pain-free state in patients with and without FD/IBS. FD/IBS was defined by the Rome IV criteria, biliary colic by the Rome III criteria, and pain-free by an Izbicki Pain Score ≤10 and visual analogue scale ≤4. We included 401 patients with abdominal pain and gallstones (assumed eligible for cholecystectomy), mean age 52 years, 76% females. Of these, 34.9% fulfilled criteria for FD/IBS. 64.1% fulfilled criteria for biliary colic and 74.9% underwent cholecystectomy, with similar operation rates in patients with and without FD/IBS. Post-cholecystectomy, 6.1% of patients fulfilled criteria for biliary colic, with no significant difference between those with and without FD/IBS at baseline (4.9% vs. 8.6%, p = 0.22). Of all patients, 56.8% was pain-free after cholecystectomy, 40.7% of FD/IBS-group vs. 64.4% of no FD/IBS-group, p < 0.001. One-third of patients eligible for cholecystectomy fulfil criteria for FD/IBS. Biliary colic is reported by only a few patients post-cholecystectomy, whereas non-biliary abdominal pain persists in >40%, particularly in those with FD/IBS pre-cholecystectomy. Clinicians should take these symptom-dependent outcomes into account in their shared decision making process. The Netherlands Trial Register NTR-7307. Registered on 18 June 2018.