Factors that Predict Relief from Upper Abdominal Pain following Cholecystectomy.
Clin Gastroenterol Hepatol. 2011 May 20;
Authors: Thistle JL, Longstreth GF, Romero Y, Arora AS, Simonson JA, Diehl NN, Harmsen WS, Zinsmeister AR
BACKGROUND & AIMS: Upper abdominal pain (UAP) in patients with gallstones is often treated by cholecystectomy but it frequently persists. We aimed to identify symptoms associated with relief. METHODS: We followed 1008 patients who received cholecystectomy for UAP at the Mayo Clinic (Rochester, MN) or Kaiser Permanente (San Diego, CA) for 12 months. A validated, self-completed biliary symptoms questionnaire identified features of UAP, gastroesophageal reflux disease (GERD), and irritable bowel syndrome (IBS); the questionnaire was given again 3 and 12 months after cholecystectomy, to identify features that predicted relief. RESULTS: Five-hundred ninety-four patients (59%) reported relief from UAP. Factors associated univariately (P < .05) with relief included frequency of UAP < 1/month, onset < 1 year preoperatively, usual duration (30 minutes to 24 hours, most often in the evening or night), and severity > 5/10. Multiple predictive features of UAP (frequency, onset, duration, or timing) were associated with increasing odds ratios (OR; 95% confidence interval) for relief, compared with 0 features: 1, 2 or 3 features (4.2 [1.1-16]; P = .03) and 4 features (6.3 [1.6-25]; P = .008). Negative univariate associations included lower abdominal pain (LAP), usual bowel pattern, nausea > 1/week, often feeling bloated or burpy, GERD, and/or IBS. There was an inverse association between relief and somatization; relief was not associated with post-prandial UAP. Multivariable logistic regression analysis revealed independent associations (P < .05) with UAP frequency, onset, and nocturnal awakening but inverse associations with LAP, abnormal bowel pattern, and frequent bloated or burpy feelings. CONCLUSIONS: UAP features and concomitant GERD, IBS, and somatization determine the odds for relief from UAP following cholecystectomy.
PMID: 21699805 [PubMed - as supplied by publisher]