Bethanechol provocation testing does not predict symptom relief after cholecystectomy for acalculous biliary pain.
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.
Smythe
A
A
Department of Surgery, Royal Hallamshire Hospital, Sheffield, K-Floor, Sheffield S10 2JF, UK.
Ahmed
R
R
Fitzhenry
M
M
Johnson
A G
AG
Majeed
A W
AW
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
D018721:Muscarinic Agonists; D010277:Parasympathomimetics; D018723:Bethanechol