Factors that predict relief from upper abdominal pain after cholecystectomy

Johnson L. Thistle, George F. Longstreth, Yvonne Romero, Amindra S. Arora, Julie A. Simonson, Nancy N. Diehl, William S. Harmsen, Alan R. Zinsmeister

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

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. 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.

Original languageEnglish (US)
Pages (from-to)891-896
Number of pages6
JournalClinical Gastroenterology and Hepatology
Volume9
Issue number10
DOIs
StatePublished - Oct 2011

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Cholecystectomy
Abdominal Pain
Irritable Bowel Syndrome
Gastroesophageal Reflux
Gallstones
Emotions
Nausea
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals

Keywords

  • Diagnosis
  • Gallstone
  • Prognosis
  • Prospective Study

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Thistle, J. L., Longstreth, G. F., Romero, Y., Arora, A. S., Simonson, J. A., Diehl, N. N., ... Zinsmeister, A. R. (2011). Factors that predict relief from upper abdominal pain after cholecystectomy. Clinical Gastroenterology and Hepatology, 9(10), 891-896. https://doi.org/10.1016/j.cgh.2011.05.014

Factors that predict relief from upper abdominal pain after cholecystectomy. / Thistle, Johnson L.; Longstreth, George F.; Romero, Yvonne; Arora, Amindra S.; Simonson, Julie A.; Diehl, Nancy N.; Harmsen, William S.; Zinsmeister, Alan R.

In: Clinical Gastroenterology and Hepatology, Vol. 9, No. 10, 10.2011, p. 891-896.

Research output: Contribution to journalArticle

Thistle, JL, Longstreth, GF, Romero, Y, Arora, AS, Simonson, JA, Diehl, NN, Harmsen, WS & Zinsmeister, AR 2011, 'Factors that predict relief from upper abdominal pain after cholecystectomy', Clinical Gastroenterology and Hepatology, vol. 9, no. 10, pp. 891-896. https://doi.org/10.1016/j.cgh.2011.05.014
Thistle JL, Longstreth GF, Romero Y, Arora AS, Simonson JA, Diehl NN et al. Factors that predict relief from upper abdominal pain after cholecystectomy. Clinical Gastroenterology and Hepatology. 2011 Oct;9(10):891-896. https://doi.org/10.1016/j.cgh.2011.05.014
Thistle, Johnson L. ; Longstreth, George F. ; Romero, Yvonne ; Arora, Amindra S. ; Simonson, Julie A. ; Diehl, Nancy N. ; Harmsen, William S. ; Zinsmeister, Alan R. / Factors that predict relief from upper abdominal pain after cholecystectomy. In: Clinical Gastroenterology and Hepatology. 2011 ; Vol. 9, No. 10. pp. 891-896.
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abstract = "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. 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.",
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AU - Diehl, Nancy N.

AU - Harmsen, William S.

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N2 - 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. 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.

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