title: Bethanechol provocation testing does not predict symptom relief after cholecystectomy for acalculous biliary pain.
abstract: BACKGROUND
  The currently accepted hypothesis to explain acalculous gallbladder pain is the lack of contractile co-ordination between the body and neck. We have previously shown that bethanechol, a muscarinic stimulant causes differential stimulation of these two regions.
  
  
  OBJECTIVE
  To evaluate the reliability of bethanechol-induced gallbladder contraction in predicting symptom relief after cholecystectomy in patients with acalculous gallbladder disease.
  
  
  METHODS
  Fifty-one patients underwent a bethanechol provocation test together with serial ultrasound to determine gallbladder emptying. McGill pain questionnaires were completed, and patients positive for pain (bethanechol provocation test +ve) were offered cholecystectomy, and patients negative for pain (bethanechol provocation test -ve) were reassessed at 6 months and offered cholecystectomy if symptoms persisted. All patients answered pain questionnaires either 6 months after surgery or as follow-up.
  
  
  RESULTS
  There was no difference in the percentage of gallbladder emptying between the bethanechol provocation test +ve and bethanechol provocation test -ve groups. Fifty-three percent of bethanechol provocation test +ve patients and 54% of bethanechol provocation test -ve patients still remained symptomatic 6 months after surgery. Conclusion. Gallbladder pain provoked by bethanechol does not predict symptom relief after cholecystectomy.
authors.affiliation: Department of Surgery, Royal Hallamshire Hospital, Sheffield, K-Floor, Sheffield S10 2JF, UK.
authors.forename: A
authors.initials: A
authors.lastname: Smythe
authors.forename: R
authors.initials: R
authors.lastname: Ahmed
authors.forename: M
authors.initials: M
authors.lastname: Fitzhenry
authors.forename: A G
authors.initials: AG
authors.lastname: Johnson
authors.forename: A W
authors.initials: AW
authors.lastname: Majeed
mesh_terms: D000328:Adult; D000368:Aged; D018723:Bethanechol / Q000494:pharmacology* / Q000627:therapeutic use; D002763:Cholecystectomy; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018721:Muscarinic Agonists / Q000494:pharmacology / Q000627:therapeutic use; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010277:Parasympathomimetics / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D018721:Muscarinic Agonists; D010277:Parasympathomimetics; D018723:Bethanechol