title: Factors that predict relief from upper abdominal pain after cholecystectomy.
abstract: OBJECTIVE
  Upper abdominal pain (UAP) in patients with gallstones is often treated by cholecystectomy but it frequently persists. We aimed to identify symptoms associated with relief.
  
  
  METHODS
  We followed 1008 patients who received cholecystectomy for gallstones and UAP at the Mayo Clinic (Rochester, Minnesota) or Kaiser Permanente (San Diego, California) for 12 months. A validated, self-completed biliary symptoms questionnaire identified features of UAP, gastroesophageal reflux disease (GERD), and irritable bowel syndrome (IBS); the questionnaire was given initially and 3 and 12 months after cholecystectomy, to identify features that predicted sustained relief of UAP.
  
  
  RESULTS
  Five hundred ninety-four patients (59%) reported relief from UAP. Factors associated univariately (P < .05) with relief included frequency of UAP ≤1 per month, onset ≤1 year preoperatively, usual duration (30 minutes to 24 hours, most often in the evening or night), and severity >5/10. Compared to no features, multiple predictive features of UAP (frequency, onset, duration, or timing) were associated with increasing odds ratios (95% confidence interval) for relief: 1, 2, or 3 features (4.2 [1.1-16]; P = .03) and 4 features (6.3 [1.6-25]; P = .008). Negative univariate associations included lower abdominal pain (LAP), usual bowel pattern, nausea ≥1 per week, often feeling bloated or burpy, GERD, and/or IBS. There was an inverse association between relief and somatization; relief was not associated with postprandial UAP. Multivariable logistic regression analysis revealed independent associations (P < .05) with UAP frequency, onset, and nocturnal awakening, but inverse associations with lower abdominal pain, abnormal bowel pattern, and frequent bloated or burpy feelings.
  
  
  CONCLUSIONS
  UAP features and concomitant GERD, IBS, and somatization determine the odds for relief from UAP after cholecystectomy.
authors.affiliation: Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA. thistle.johnson@mayo.edu
authors.forename: Johnson L
authors.initials: JL
authors.lastname: Thistle
authors.forename: George F
authors.initials: GF
authors.lastname: Longstreth
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Romero
authors.forename: Amindra S
authors.initials: AS
authors.lastname: Arora
authors.forename: Julie A
authors.initials: JA
authors.lastname: Simonson
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Diehl
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000453:epidemiology; D002140:California; D002763:Cholecystectomy; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011379:Prognosis; D012307:Risk Factors; D011795:Surveys and Questionnaires