Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness
One of the syndromes commonly encountered in the outpatient clinic is flatulent dyspepsia. By this we mean epigastric discomfort after meals, a feeling of fullness so that tight clothing is loosened, eructation with temporary relief, and regurgitation of sour fluid to the mouth with heartburn. The patient is usually a middle-aged obese woman. Radiological investigation may reveal gall stones, a hiatus hernia, a peptic ulcer, various combinations of these conditions, or nothing. We are particularly interested in the cases with gall stones. Are these cause or coincidence ? When the patient asks, " If you take out my gall bladder, shall I lose my indigestion ?" what is the surgeon to say ? Price (1963) investigated 142 women aged 50-70 in one general practice and found dyspepsia just as common in women with normal cholecystograms as in those with stones; he concluded that the dyspepsia was not due to the gall stones and should not influence the treatment. Smith and Sherlock (1964) claim that cholecystectomy gives excellent results unless the dyspepsia is really due to a duodenal ulcer, a hiatus hernia, diverticulitis coli, chronic constipation, overeating, or an unfaithful husband; since most of these patients at least overeat, this rather begs the question. According to Maingot (1956), cholecystectomy has little or no effect in curing the unpleasant symptoms of flatulent dyspepsia. Capper et al. (1967) provided an explanation for the dyspepsia associated with gall stones, and were promptly rebuked by French (1967) for perpetuating the myth that gall stones commonly cause flatulent dyspepsia.