Gastroenterology and Hepatology from Bed to Bench

Abstract

Aim: To determine the co-incidence of gallstones with upper GI disease in patients who were candidate for elective cholecystectomy.

Background: Typical pain of gallstones frequently cause special pattern which can usually be distinguished from symptoms of other organic and functional diseases. But patient with cholelithiasis and atypical pattern of abdominal pain seems to bring about a challenging clinical problem to the surgeon.

Patients and methods: We designed a retrospective study to evaluate clinically and pathologically 360 patients whom were presented to Shohadaye Tajrish hospital with sonographic documented gallstones which were selected for elective cholecystectomy by the surgeon. They have also undergone esophagogastroduodenoscopy (EGD) before their cholecystectomy operation as a part of their routine preoperational evaluations, between April 2001 and March 2006. Endoscopic examination was performed for all treated patients 1 to 4 days before their operations.

Results: Among these 360 patients, 178 patients (49.4 %) experienced atypical abdominal pain, the other 182 patients (50.6 %) presented with typical abdominal pain. These two groups were comparable in sex and age. From those with typical pattern of pain, only one had positive findings in EGD (0.54 %) while among the 178 patients with atypical pain, 148 (83 %) had abnormal findings in EGD (p<0.001). The surgery was postponed for patients with ulcer, and anti ulcer treatment was started. In 16 patients, the symptoms associated with colelithiasis subsided after healing of the ulcer. Of 178 patients with atypical pain, 11 cases (6 %) exhibited evidences of malignancy in their upper gastrointestinal (GI) pathology. Cholelithiasis in these two last patients was incidental finding, and a cholecystectomy was not performed.

Conclusion: Because of higher incidence of concurrent upper GI problems in patients with gallstones and atypical abdominal pain, esophagogastroduodenoscopy prior to elective cholecystectomy in this group of patients could be clinically helpful and also may be cost effective.