The association between cholecystectomy and gastroesophageal reflux symptoms: a prospective controlled study.
OBJECTIVE
A large controlled prospective observational study to compare pre- and postsurgery changes in reflux symptoms between cholecystectomy and hernia repair surgery patients.


BACKGROUND
Six studies have suggested that gastroesophageal reflux worsens after cholecystectomy. However, all these studies had design limitations.


METHODS
We recruited 302 patients scheduled to undergo elective cholecystectomy (study group) or hernia repair (controls) at 2 hospitals. Both groups filled out the validated Reflux Symptom Score (RSS) and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires 1 to 15 days prior to and 4 to 12 weeks after the operation. Changes in symptom scores between the pre and postsurgery assessments were measured, and compared between the 2 groups.


RESULTS
Baseline RSS and GSRS reflux subscores were higher in the study group than controls (1.44 vs. 1.02 and 1.91 vs. 1.43, respectively; P < 0.05). There were no significant differences in any of the symptom score changes between the 2 groups except for the GSRS pain subscore, which decreased more in the study group than the control group (-0.59 vs. -0.10; P < 0.001). With regard to reflux, the RSS decreased by -0.34 in the study group and -0.14 in controls (P = 0.27), while the GSRS reflux subscore decreased by -0.32 in the study group and -0.05 in controls (P = 0.12). GSRS diarrhea and constipation subscores decreased slightly after surgery, to the same extent in both groups.


CONCLUSIONS
This large prospective controlled study, the only one using validated reflux symptom questionnaires, shows that cholecystectomy does not lead to an increase in reflux symptoms. As expected, GSRS pain subscores were decreased in the cholecystectomy group but not the controls.
Gastroenterology Section, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, USA. otto.lin@vmmc.org
Otto S
OS
Lin
Richard A
RA
Kozarek
Andrew
A
Arai
S Ian
SI
Gan
Michael
M
Gluck
Geoffrey C
GC
Jiranek
Kris V
KV
Kowdley
George
G
Triadafilopoulos
D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011795:Surveys and Questionnaires