Functional Dyspepsia and Irritable Bowel Syndrome are Highly Prevalent in Patients With Gallstones and Are Negatively Associated With Outcomes After Cholecystectomy: A Prospective, Multicenter, Observational Study (PERFECT - Trial).

Abstract

OBJECTIVE:

To determine the prevalence of FD and 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.

SUMMARY BACKGROUND DATA:

More than 30% of patients with symptomatic cholecystolithiasis reports persisting pain postcholecystectomy. Coexistence of FD/IBS may contribute to this unsatisfactory outcome.

METHODS:

We conducted a multicenter, prospective, observational study (PERFECT-trial). Patients ≥18 years with abdominal pain and gallstones were included at 5 surgical outpatient clinics between 01/2018 and 04/2019. Follow-up was 6 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.

RESULTS:

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. Postcholecystectomy, 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.

CONCLUSIONS:

One third of patients eligible for cholecystectomy fulfil criteria for FD/IBS. Biliary colic is reported by only a few patients postcholecys-tectomy, whereas nonbiliary abdominal pain persists in >40%, particularly in those with FD/IBS precholecystectomy. Clinicians should take these symptom-dependent outcomes into account in their shared decision-making process.

TRIAL REGISTRATION:

The Netherlands Trial Register NTR-7307. Registered on 18 June 2018.

• Authors: Judith J de Jong, Carmen S S Latenstein, Djamila Boerma, Eric J Hazebroek, David Hirsch, Joost T Heikens, Joop Konsten, Fatih Polat, Marten A Lantinga, Cornelis J H M van Laarhoven, Joost P H Drenth, Philip R de Reuver
• Journal: Annals of surgery (Ann Surg) Vol. 275 Issue 6 Pg. e766-e772 (06 01 2022) ISSN: 1528-1140 [Electronic] United States
• PMID: 32889877 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Abdominal Pain (epidemiology, etiology)
• Cholecystectomy
• Colic (epidemiology, etiology, surgery)
• Dyspepsia (complications, etiology)
• Female
• Gallstones (complications, surgery)
• Humans
• Irritable Bowel Syndrome (complications, epidemiology)
• Male
• Middle Aged
• Prospective Studies