Factors that Predict Relief from Upper Abdominal Pain following Cholecystectomy.

Link to article at PubMed

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]

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