- 作者：Johnson L. Thistle<sup>?/sup><sup> ; sup><sup>thistle.johnson@mayo.edusup> ; George F. Longstreth<sup>&Dagger ; sup> ; Yvonne Romero<sup>?/sup> ; Amindra S. Arora<sup>?/sup> ; Julie A. Simonson<sup>?/sup> ; Nancy N. Diehl<sup>§ ; sup> ; William S. Harmsen<sup>?/sup> ; Alan R. Zinsmeister<sup>?/sup>
- 关键词：Gallstone ; Diagnosis ; Prognosis ; Prospective Study
- 刊名：Clinical Gastroenterology and Hepatology
- 出版年：2011
- 出版时间：October 2011
- 年：2011
- 卷：9
- 期：10
- 页码：891-896
- 全文大小：736 K
ss=""h4"">Background & Aims
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.ss=""h4"">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.
ss=""h4"">Results
Five hundred ninety-four patients (59 % ) reported relief from UAP. Factors associated univariately (P < .05) with relief included frequency of UAP ? per month, onset ? 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?6]; P = .03) and 4 features (6.3 [1.6?5]; P = .008). Negative univariate associations included lower abdominal pain (LAP), usual bowel pattern, nausea ? 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.
ss=""h4"">Conclusions
UAP features and concomitant GERD, IBS, and somatization determine the odds for relief from UAP after cholecystectomy.