Post-cholecystectomy symptoms were caused by persistence of a functional gastrointestinal disorder

Table 1 Assessment of functional abdominal symptoms (functional gastrointestinal disorder)

Perspiration

Intolerance to food

Acid regurgitation

Heartburn

Difficulty swallowing, food sticking in the lower esophagus

Nausea

Loss of appetite (anorexia)

Feeling full after eating very little (early satiety)

Feeling of abdominal fullness or bloating

Abdominal distension, which requires loosening of the belt

Frequent loose bowel movements (or more often than usual)

Constipation (or less bowel movements than usual)

Alternating constipation and loose bowel movements

Difficulty passing stools with straining, urgency or feeling of incomplete evacuation

Abdominal pain or discomfort is relieved by bowel movements (passing of stool)

Rate the frequency of the following symptoms associated with abdominal pain during the last 3 mo or longer, using the following scale: 0: Not at all or rarely (less than 10% of the episodes); 1: Occasionally (less than 50% of the episodes); 2: Very often (more than 50% of the episodes); 3: Almost always (more than 80% of the episodes).

Table 2 Assessment of pain symptoms

Had an abdominal pain attack at least once for the last 3 mo or longer?

Experienced either pain or discomfort in the abdomen of a continuous steady nature at least once per week for the last 3 mo or longer?

For women: Did the onset of pain begin during pregnancy or soon after pregnancy?

Evaluated in the Emergency Department or seek medical attention for the abdominal pain?

Admitted to the hospital for the abdominal pain?

Estimate how often pain medications are required for the pain:

Not at all or rarely (less than 10% of the episodes)

Occasionally (less than 50% o the episodes)

Very often (more than 50% of the episodes)

Almost always (more than 80% of the episodes)

Time-interval during which the pain most often occurs:

7 am – 12 pm

12 pm – 6 pm

6 pm – 11 pm

11 pm – 7 am

Highly variable and unable to predict time of onset

Rate how often the pain occurs in the following abdominal areas:

Right upper quadrant1

Left upper quadrant1

Right lower quadrant1

Left lower quadrant1

Midline or center of the upper abdomen1

Is there often an area where the pain is strongest (able to point with one or two fingers):

Right upper quadrant

Left upper quadrant

Right lower quadrant

Left lower quadrant

Midline or center of the upper abdomen

Highly variable and unable to predict one area

No

Experience discomfort in the right upper quadrant when bending forward?

Abdominal pain radiates from where it started?

If yes, where does it radiate most often?

Right upper back beneath the right shoulder blade

Upper back between the shoulder blades

Lower back

None of these places mentioned

Highly variable and unable to predict a dominant area

Estimate the number of pain attacks over the last 3 mo

Estimate the usual duration of a pain attack in hours and minutes

Experience urge to move around during a pain attack1

Choose one of four patterns describing pain attacks (depicted by graphs):

Low-grade warning pain followed by a steady rise to a maximal constant pain, gradually getting better after a while

Low-grade warning pain followed by a steady rise to a maximal degree with occasional waves of pain, gradually getting better after a while

Pain begins suddenly with maximal intensity and improves over time

Pain begins suddenly with maximal intensity and persists with waves of pain until it goes away

Rate level of maximal pain intensity by 100 mm visual analogue scale score-scale

Pain attacks are defined as suddenly appearing pain that is distinct from, and stronger than any continuous, steady pain or discomfort.

¹The pain occurrence in each area is rated as: not at all or rarely (less than 10% of the episodes), occasionally (less than 50% o the episodes), very often (more than 50% of the episodes) or almost always (more than 80% of the episodes).

Table 3 Assignment of a clinical gallstone symptom score to different preoperative symptom frequency groups (%)

		Percent of patients with symptoms according to pain presentation
Symptom	Score	Severe	Moderate	Mild	Chronic
Pain in upper abdomen: Pain most common in right upper quadrant or intensifies when bending forward or lying on the right side	2	100	96.6	94.1	88.2
Pain attacks commonly last more than one hour	1	73.0	66.7	76.5	46.2
Pain in a ”plateau fashion”	1	62.2	72.9	67.6	64.3
Urge to move during pain attacks	1	51.4	69.0	58.8	84.6
Pain commonly occurs at night	1	43.2	61.0	50.0	29.4
Pain radiation to the back	1	40.5	47.5	38.2	58.8
Nausea during pain attacks	1	61.1	48.3	52.9	50.0
Use of analgesics in > 50% of pain attacks	1	54.0	54.3	44.1	41.2
Perspiration during pain attacks	1	36.1	41.4	41.2	60.0

Table 4 Demographics of the study population of 153 patients and 115 follow-up responders n (%), mean age (range, yr)

Symptom frequency group	Females	Males	Total
All groups	122 (79.7), 47 (17-81)	31 (20.3), 51 (28-85)	153 (100), 48 (17-85)
Severe disease	31, 45 (17-81)	6, 44 (25-64)	37 (24.2), 45 (17-81)
Moderate disease	47, 44 (20-72)	12, 53 (39-70)	59 (38.6), 46 (20-72)
Mild disease	26, 53 (25-78)	8, 52 (34-85)	34 (22.2), 53 (25-85)
Chronic disease	18, 53 (23-81)	5, 55 (30-80)	23 (15.0), 54 (23-81)
Responders to follow-up	89 (77.4), 49 (20-81)	26 (22.6), 52 (25-85)	115 (75.2), 50 (20-85)

χ² for gender; P = 0.889.

Table 5 Changes in gallstone severity score by symptom frequency group in 115 responding patients from the study population of 153 patients n (%)

Preoperative SFG	Patients	Preoperative		Responders	Postoperative		mean % reduction in GSS
		mean GSS	mean VAS		mean GSS	mean VAS
Severe disease	37 (24.2)	6.11	81.1	29 (78.4)	1.76	33.0	69.1
Moderate disease	59 (38.6)	6.47	86.6	41 (69.5)	1.32	15.8	78.7
Mild disease	34 (22.2)	6.09	81.3	26 (76.5)	1.04	12.8	87.0
Chronic disease	23 (15.0)	4.35	76.8	19 (82.6)	1.00	8.9	62.7

SFG: Symptom frequency groups; GSS: Gallstone symptom score; VAS: Visual analogue scale score.

Table 6 Symptomatic improvement in 115 patients after cholecystectomy n (%)

	Groups
	Asymptomatic but improved	Symptomatic or worse	Unchanged	P value1
Patients				0.651
All patients	76 (66.1)	28 (24.3)	11 (9.6)
Severe disease	15 (51.7)	10 (34.5)	4 (13.7)
Moderate disease	27 (65.8)	9 (22.0)	5 (12.2)
Mild disease	20 (76.9)	5 (19.2)	1 (3.9)
Chronic disease	14 (73.7)	4 (21.0)	1 (5.3)
Age				0.490
< 60	54 (64.3)	23 (27.4)	7 (8.4)
> 60	22 (71.0)	5 (16.1)	4 (12.9)
Gender				0.573
Women	56 (62.9)	24 (27.0)	9 (10.1)
Men	20 (76.9)	4 (15.4)	2 (7.7)

¹P values from χ² calculation.

Table 7 Presence of pre- and post-operative functional gastrointestinal disorder in 115 patients with different n (%)

Presence of FGID	Patients	Asymptomatic	Symptomatic, improved	Unchanged or worse	P value1
None pre-operative	13 (11.3)	11 (84.6)	2 (15.4)	0
Present pre-operative	102 (88.7)	65 (63.7)	26 (25.5)	11 (10.8)	0.449
None post-operative	49 (42.6)	42 (85.7)	7 (14.3)	0
Present post-operative	66 (57.4)	34 (51.5)	21 (31.8)	11 (16.7)	0.001
Total	115 (100)	76 (66.1)	28 (24.3)	11 (9.6)

FGID: Functional gastrointestinal disorder.

¹P values from χ² calculation.