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Cholecystectomy and Clinical Presentations of Gastroparesis

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Abstract

Background

Many patients with gastroparesis have had their gallbladders removed.

Aim

To determine if clinical presentations of patients with gastroparesis differ in those with prior cholecystectomy compared to patients who have not had their gallbladder removed.

Methods

Gastroparetic patients were prospectively enrolled in the NIDDK Gastroparesis Registry. Detailed history and physical examinations were performed; patients filled out questionnaires including patient assessment of GI symptoms.

Results

Of 391 subjects with diabetic or idiopathic gastroparesis (IG), 142 (36 %) had a prior cholecystectomy at the time of enrollment. Patients with prior cholecystectomy were more often female, older, married, and overweight or obese. Cholecystectomy had been performed in 27/59 (46 %) of T2DM compared to 19/78 (24 %) T1DM and 96/254 IG (38 %) (p = 0.03). Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization, and had a worse quality of life. Independent characteristics associated with prior cholecystectomy included insidious onset (OR = 2.06; p = 0.01), more comorbidities (OR = 1.26; p < 0.001), less severe gastric retention (OR(severe) = 0.68; overall p = 0.03) and more severe symptoms of retching (OR = 1.19; p = 0.02) and upper abdominal pain (OR = 1.21; p = 0.02), less severe constipation symptoms (OR = 0.84; p = 0.02), and not classified as having irritable bowel syndrome (OR = 0.51; p = 0.02). Etiology was not independently associated with a prior cholecystectomy.

Conclusions

Symptom profiles in patients with and without cholecystectomy differ: postcholecystectomy gastroparesis patients had more severe upper abdominal pain and retching and less severe constipation. These data suggest that prior cholecystectomy is associated with selected manifestations of gastroparesis.

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References

  1. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1592–1622.

    Article  PubMed  Google Scholar 

  2. Soykan I, Sivri B, Sarosiek I, et al. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci. 1998;43:2398–2404.

    Article  PubMed  CAS  Google Scholar 

  3. Thistle JL, Longstreth GF, Romero Y, et al. Factors that predict relief from upper abdominal pain after cholecystectom. Clin Gastroenterol Hepatol. 2011;9:891–896.

    Article  PubMed  Google Scholar 

  4. Dibaise JK. Evaluation and management of functional biliary pain in patients with an intact gallbladder. Expert Rev Gastroenterol Hepatol. 2009;3:305–313.

    Article  PubMed  Google Scholar 

  5. Deeb F, Lacy B, Yoo H, Mitchell A, Ravich W. Gastroparesis: a risk factor for cholecystectomy? Am J Gastroenterol. 2001;96:S51–S52.

    Article  Google Scholar 

  6. Parkman HP, Yates K, Hasler WL, et al. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology. 2011;140:101–115.

    Article  PubMed  Google Scholar 

  7. Hasler WL, Parkman HP, Wilson LA, et al. Psychological dysfunction is associated with symptom severity but not disease etiology or degree of gastric retention in patients with gastroparesis. Am J Gastroenterol. 2010;105:2357–2367.

    Article  PubMed  Google Scholar 

  8. Abell TL, Bernstein VK, Cutts T, et al. Treatment of gastroparesis: a multidisciplinary clinical review. Neurogastroenterol Motil. 2006;18:263–283.

    Article  PubMed  CAS  Google Scholar 

  9. Rentz AM, Kahrilas P, Stanghellini V, et al. Development and psychometric evaluation of the patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) in patients with upper gastrointestinal disorders. Qual Life Res. 2004;13:1737–1749.

    Article  PubMed  CAS  Google Scholar 

  10. Revicki DA, Rentz AM, Dubois D, et al. Development and validation of a patient-assessed gastroparesis symptom severity measure: the gastroparesis cardinal symptom index. Aliment Pharmacol Ther. 2003;18:141–150.

    Article  PubMed  CAS  Google Scholar 

  11. De la Loge C, Trudeau E, Marquis P, et al. Cross-cultural development and validation of a patient self-administered questionnaire to assess quality of life in upper gastrointestinal disorders: the PAGI-QOL. Qual Life Res. 2004;13:1751–1762.

    Article  PubMed  Google Scholar 

  12. Ware JE, Kosinski M, Dewey JE. How to Score Version 2 of the SF-36 ® Health Survey. Lincoln, RI: QualityMetric Incorporated; 2000.

    Google Scholar 

  13. Beck AT, Steer RA, Ball R, Ranieri W. Comparison of beck depression inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67:588–597.

    Article  PubMed  CAS  Google Scholar 

  14. Richter P, Werner J, Heerlein A, et al. On the validity of the Beck Depression Inventory. A review. Psychopathology. 1998;31:160–168.

    Article  PubMed  CAS  Google Scholar 

  15. Spielberger C, Gorsuch R, Lushene R. Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press; 1970.

    Google Scholar 

  16. Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol. 2000;95:1456–1462.

    Article  PubMed  CAS  Google Scholar 

  17. Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy. A joint report of the society of nuclear medicine and the American Neurogastroenterology and Motility Society. Am J Gastroenterology. 2008;103:753–763.

    Article  Google Scholar 

  18. Camilleri M. Diabetic Gastroparesis. N Engl J Med. 2007;356:820–829.

    Article  PubMed  CAS  Google Scholar 

  19. Drossman DA, Corazziari E, Delvaux M, et al. Rome III and the functional gastrointestinal disorders, 3rd ed. 2006.

  20. Agresti A. Categorical data analysis. New York: Wiley; 1990.

    Google Scholar 

  21. Hosmer D, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley; 2000.

    Book  Google Scholar 

  22. Akaike H. A new look at the statistical model identification. IEEE Trans Autom Control. 1974;19:716–723.

    Article  Google Scholar 

  23. Parkman HP, Yates K, Hasler WL, et al. Similarities and differences between diabetic and idiopathic gastroparesis. Gastroenterology. 2011;9:1056–1064.

    Google Scholar 

  24. SAS Institute, Inc. SAS software, version 9.3 of the SAS system for Windows. Cary, NC, 2002–2010. StataCorp. 2011. Stata statistical software: release 12. College Station, TX: StataCorp LP.

  25. Kennedy AL, Saccone GT, Mawe GM. Direct neuronal interactions between the duodenum and the sphincter of Oddi. Curr Gastroenterol Rep. 2000;2:104–111.

    Article  PubMed  CAS  Google Scholar 

  26. Koksoy FN, Bulut T, Kose H, et al. Effects of cholelithiasis and cholecystectomy on gastric emptying. J R Coll Surg Edinb. 1994;39:164–167.

    PubMed  CAS  Google Scholar 

  27. Stavraka A, Madan AK, Frantzides CT, et al. Gastric emptying time, not enterogastric reflux, is related to symptoms after upper gastrointestinal/biliary surgery. Am J Surgery. 2002;184:595–600.

    Article  Google Scholar 

  28. Riezzo G, Chiloiro M, Pezzolla F, et al. Effects of cholecystectomy on gastric emptying, and myoelectrical activity in man. Arch Physiol Biochem. 1997;105:545–551.

    Article  PubMed  CAS  Google Scholar 

  29. Berhane T, Hausken T, Olafsson S, et al. Ultrasound examination shows disturbed proximal gastric function in symptomatic gallstone patients with dyspepsia and improvement after cholecystectomy—gallstones and gastric emptying. Ultrschall Med. 2006;27:451–455.

    Article  CAS  Google Scholar 

  30. Vignolo MC, Savassi-Rocha PR, Coelho LG, et al. Gastric emptying before and after cholecystectomy in patients with choleystolithiasis. Hepatogastroenterology. 2008;55:850–854.

    PubMed  Google Scholar 

  31. Brugstaller M, Barthel S, Kasper H. Diabetic gastroparesis and gallbladder disease. Ultrasound diagnosis after multiple-component meals. Dtsch Med Wochenschr. 1992;117:1868–73.32.

    Google Scholar 

  32. Geiger TM, Awad ZT, Burgard M, et al. Prognostic indicators of quality of life after cholecystectomy for biliary dyskinesia. Am Surg. 2008;74:400–404.

    PubMed  Google Scholar 

  33. Chumpitazi BP, Malowitz SM, Moore W, Ggopalakrishna GS, Shulman RJ. Concomitant gastroparesis negatively affects children with functional gallbladder disease. J Pediatr Gastroenterol Nutr. 2012;54:776–779.

    Article  PubMed  Google Scholar 

  34. Lorusso D, Porcelli P, Pezzolla F, et al. Persistent dyspepsia after laparoscopic cholecystectomy. The influence of psychological factors. Scand J Gastroenterol. 2003;38:653–658.

    Article  PubMed  CAS  Google Scholar 

  35. Longstreth GF, Yao JF. Irritable bowel syndrome and surgery: a multivariable analysis. Gastroenterology. 2004;126:1665–1673.

    Article  PubMed  Google Scholar 

  36. ter Borg EJ, Gerards-Rociu E, Haanen HC, Westers P. High frequency of hysterectomies and appendectomies in fibromyalgia compared with rheumatoid arthritis: a pilot study. Clin Rheumatol. 1999;18:1–3.

    Article  PubMed  Google Scholar 

  37. Hasler WH, Schoenfeld P. Systematic review: abdominal and pelvic surgery in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2003;17:997–1005.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The Gastroparesis Clinical Research Consortium (GpCRC) is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (grants U01DK073983, U01DK073975, U01DK073985, U01DK074007, U01DK073974, U01DK074008).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Gastroenterology Section, Parkinson Pavilion, School of Medicine, Temple University, 8th Floor 3401 North Broad Street, Philadelphia, PA, 19140, USA

    Henry P. Parkman

  2. Johns Hopkins University, Baltimore, MD, USA

    Katherine Yates, Linda Lee, Aynur Unalp-Arida & James Tonascia

  3. University of Michigan, Ann Arbor, MI, USA

    William L. Hasler

  4. Stanford University, Palo Alto, CA, USA

    Linda Nguyen & Pankaj J. Pasricha

  5. California Pacific Medical Center, San Francisco, CA, USA

    William J. Snape

  6. Mayo Clinic, Rochester, MN, USA

    Gianrico Farrugia

  7. Wake Forest University, Winston-Salem, NC, USA

    Kenneth L. Koch & Jorge Calles

  8. University of Mississippi, Jackson, MS, USA

    Thomas L. Abell

  9. Texas Tech University, Lubbock, TX, USA

    Irene Sarosiek & Richard W. McCallum

  10. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA

    Frank Hamilton

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  1. Henry P. Parkman
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  2. Katherine Yates
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Corresponding author

Correspondence to Henry P. Parkman.

Additional information

All authors belong to the NIDDK Gastroparesis Clinical Research Consortium (GpCRC).

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Parkman, H.P., Yates, K., Hasler, W.L. et al. Cholecystectomy and Clinical Presentations of Gastroparesis. Dig Dis Sci 58, 1062–1073 (2013). https://doi.org/10.1007/s10620-013-2596-y

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  • DOI: https://doi.org/10.1007/s10620-013-2596-y

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