March 13, 2017 In Acid Reflux Blog By Elias Darido
At Houston heartburn and Reflux Center, more than 50% of patients presenting for GERD evaluation have already underwent a cholecystectomy. Chronic proton pump inhibitor use by GERD patients may increase the incidence of biliary stasis and choleltihiasis. However, many patients have had their GERD symptoms mistaken for biliary colic. Cholecystectomy is a very common procedure performed by general surgeons. Primary care physicians tend to order a gallbladder ultrasound/HIDA scan for epigastric pain much more commonly than upper endoscopy and ambulatory pH testing. Cholelithiasis is present in 30% of the population. Most cholelithiasis cases need no intervention. It is crucial to differentiate GERD pain from biliary colic prior to committing a patient to any surgical intervention. A healthy gallbladder has several important functions some of which we still don’t know about. This study shows that cholecystectomy increases the risk of bile reflux and esophago-gastric mucosa injury. I suspect the risk of bile reflux and mucosal injury is highest in GERD patients who undergo an unindicated cholecystectomy. Biliary colic and GERD pain may have overlapping presentations. A thorough history taking and sharp clinical acumen coupled with proper testing and evaluation are therefore needed to avoid doing harm and unnecessary surgery.
Cahan MA: Proton pump inhibitors reduce gallbladder function. Surg. Endosc. 20 (9): 1364–1367.
Disclaimer: lifewithnogallbladder does associate with the ‘gold standard treatment for GERD’ being surgical’