Prevalence of Helicobacter pylori, gastric myoelectrical activity, gastric mucosal changes and dyspeptic symptoms before and after laparoscopic cholecystectomy.
OBJECTIVE
Cholecystectomy may lead to anatomic and functional alterations which eventually induce reflux of duodenal contents with its sequlae. The aim of this study is to evaluate the prevalence of Helicobacter pylori (H. pylori), gastric myoelectrical activities and gastric mucosal changes before and after laparoscopic cholecystectomy.


METHODS
This prospective study has been carried out on 46 patients (20 M & 26 F) with mean age 41.7+/-0.2 years for whom laparoscopic cholecystectomy for gallstones was carried out. Prior to the operation and 1 year after, all patients were subjected to clinical assessment, upper gastrointestinal endoscopy, histopathology of antral mucosa, reflux gastritis score, detection of H. pylori and electrogastrography.


RESULTS
There was an increase in the postoperative suggestive symptoms of reflux gastritis compared to the preoperative: epigastric pain increased from 8 (17.4%) to 11 (23.39%) patients, nausea increased from 6 (13%) to 12 (26.1%) and bilious vomiting increased from 3 (6.5%) to 11 (23.9%) patients. Mild antral gastritis was detected endoscopically before laparoscopic cholecystectomy in 20 patients (43.5%) and increased to 27 patients (58.7%) after surgery. Meanwhile, severe antral gastritis and erosions were only detected after the operation in 10 (21.7%) patients, respectively. The histological results showed an increase of the histopathologic score of reflux gastritis after cholecystectomy from 4.28 (+/-1.56) to 9.28 (+/-1.99) (p<0.001). Active chronic superficial gastritis decreased from 23 (50%) to 13 (28.2%) patients while the inactive form increased from 15 (32.6%) to 23 (50%) patients. Also, chronic atrophic gastritis, intestinal metaplasia and dysplasia were detected postoperatively in 4 (8.6%) patients. The incidence of H. pylori infection was decreased from 32 (69.6%) to 19 (41.3%) patients (p<0.0001). Electrogastrography abnormal frequency decreased in fasting from 26.1% to 8.7% (p<0.001), and postprandial from 16.9% to 4.4% recording (p<0.002). On the other hand, there was an increase in the number of patients with decreased electrogastrography amplitude after a meal from 4.3% to 28.3% (p<0.0001).


CONCLUSIONS
Our study shows that dyspeptic symptoms, endoscopic and histologic gastric changes as well as electrogastrography abnormalities are present before and increase after cholecystectomy; meanwhile H. pylori colonization in gastric mucosa is decreased after cholecystectomy.
Gad Elhak
N
N
Gastroenterology Surgical Center, Mansoura University, Egypt. gadelhak_n_eg@hotmail.com
Abd Elwahab
M
M
Nasif
W A
WA
Abo-Elenein
A
A
Abdalla
T
T
el-Shobary
M
M
Haleem
M
M
Yaseen
A
A
el-Ghawalby
N
N
Ezzat
F
F
D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D004415:Dyspepsia / Q000382:microbiology; D004594:Electrophysiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology*; D005756:Gastritis / Q000473:pathology; D016481:Helicobacter Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D015995:Prevalence; D011446:Prospective Studies; D013270:Stomach / Q000502:physiology*