title: Morpho-functional gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease.
abstract: BACKGROUND
  Cholecystectomy, gold standard treatment for gallbladder lithiasis, is closely associated with increased bile reflux into the stomach as amply demonstrated by experimental studies. The high prevalence of gallstones in the population and the consequent widespread use of surgical removal of the gallbladder require an assessment of the relationship between cholecystectomy and gastric mucosal disorders.Morphological evaluations performed on serial pre and post - surgical biopsies have provided new acquisitions about gastric damage induced by bile in the organ.
  
  
  METHODS
  62 elderly patients with gallstone related disease were recruited in a 30 months period. All patients were subjected to the most appropriate treatment (Laparoscopic cholecystectomy). The subjects had a pre-surgical evaluation with:• dyspeptic symptoms questionnaire,• gastric endoscopy with body, antrum, and fundus random biopsies,• histo-pathological analysis of samples and elaboration of bile reflux index (BRI).The same evaluation was repeated at a 6 months follow-up.
  
  
  RESULTS
  In our series the duodeno-gastric reflux and the consensual biliary gastritis, assessed histologically with the BRI, was found in 58% of the patients after 6 months from cholecystectomy. The demonstrated bile reflux had no effect on H. pylori's gastric colonization nor on the induction of gastric precancerous lesions.
  
  
  CONCLUSIONS
  Cholecystectomy, gold standard treatment for gallstone-related diseases, is practiced in a high percentage of patients with this condition. Such procedure, considered by many harmless, was, in our study, associated with a significant risk of developing biliary gastritis after 6 months during the postoperative period.
authors.affiliation: Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University Federico II of Naples, Via Pansini 5, 80131 Naples, Italy. giovanni.aprea@yahoo.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Aprea
authors.forename: Alfonso
authors.initials: A
authors.lastname: Canfora
authors.forename: Antonio
authors.initials: A
authors.lastname: Ferronetti
authors.forename: Antonio
authors.initials: A
authors.lastname: Giugliano
authors.forename: Francesco
authors.initials: F
authors.lastname: Guida
authors.forename: Antonio
authors.initials: A
authors.lastname: Braun
authors.forename: Melania
authors.initials: M
authors.lastname: Battaglini Ciciriello
authors.forename: Federica
authors.initials: F
authors.lastname: Tovecci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mastrobuoni
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cardin
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D004383:Duodenogastric Reflux / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000601:surgery*; D005756:Gastritis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016481:Helicobacter Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011230:Precancerous Conditions / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology