Surgical referral for cholecystectomy in patients with atypical symptoms

• Published in: The American journal of surgery Vol. 220; no. 6; pp. 1451 - 1455
• Main Authors: Kapadia, Sonam G., Kaji, Amy H., Hari, Danielle M., Ozao-Choy, Junko, Chen, Kathryn T.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2020; Elsevier Limited
• Subjects: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Atypical biliary colic; Bile; Calculi; Cholecystectomy; Clinical outcomes; Colic; Decision making; Dyspepsia; Dyspepsia - complications; Female; Gallstones; Gallstones - surgery; Gastritis; Gastritis - complications; Gastroesophageal reflux; Helicobacter Infections - complications; Helicobacter pylori; Humans; Infections; Intervention; Laparoscopy; Male; Middle Aged; Pain; Patients; Referral and Consultation - statistics & numerical data; Retrospective Studies; Signs and symptoms; Surgeons; Cholecystectomy; Helicobacter pylori; Dyspepsia; Atypical biliary colic
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2020.10.016

Cholelithiasis referrals often present with concomitant or isolated atypical symptoms such as reflux, bloating, or epigastric pain. We sought to identify the impact of preoperative symptomatology of atypical or dyspepsia-type biliary colic on operative and non-operative clinical outcomes.
A retrospective review of patients referred for gallstone disease from 2014 to 2018 at a single institution in Los Angeles County was performed.
Of 746 patients evaluated for gallstone disease, 87.4% (n = 652) underwent cholecystectomy – 90.8% (n = 592) had symptom resolution postoperatively whereas 9.2% (n = 60) did not. Over half presented with concomitant atypical and/or dyspepsia symptoms (n = 411). Heartburn/reflux was significantly associated with unresolved symptoms postoperatively (OR 2.1,1.0–4.4, p = 0.04). Overall, 11.1% (n = 83) of all 746 patients and 20.2% of patients with atypical and/or dyspepsia symptoms improved with medical management of gastritis or Helicobacter pylori triple therapy pre/post-operatively.
Atypical biliary colic and/or dyspepsia is associated with unresolved symptoms following cholecystectomy. Such patients may benefit from H. pylori testing or PPI trial prior to cholecystectomy.
•Surgical referrals for atypical biliary symptoms should elicit broad differentials.•Eliciting history of atypical symptoms preoperatively guides management.•Preoperative heartburn is associated with unresolved symptoms post-cholecystectomy.•Non-operative management of gastritis or H. pylori may alleviate atypical symptoms.