Gastroduodenal Peptic Ulcers, Duodenal Adhesions, and Upper Gastrointestinal Motility Disturbances in Patients Who Have Undergone Cholecystectomy

Abstract

The frequency of duodenal and gastric ulcer disease, the thickness of the pyloric muscle, and adhesions of the duodenum were evaluated in a routine, consecutive, prospective autopsy series of 100 patients, and the length of the pyloric canal, adhesions of the duodenum, and motility disturbances in the upper gastrointestinal series were studied in a separate radiologic material of 69 symptomatic patients with cholecystectomy in their history. Both series were compared with matched unoperated controls. The frequency of active gastric ulcers and ulcer scars was observed to be increased and that of active duodenal ulcers and ulcer scars decreased among the cholecystectomized patients in the autopsy series (p = 0.01 in both cases). This difference was not as pronounced when only active ulcers were included, but for active duodenal ulcers the difference was still significant (p = 0.04). One-fourth of the cholecystectomized patients but none of the controls had severe adhesions of the duodenum. In the autopsy series the thickness of the pyloric muscle and in the radiologic series the length of the radiologic pyloric canal were thickened/lengthened in an average of 26%/11% in patients who had undergone cholecystectomy (p < 0,001 and p<0.10, respectively). The lengthening of the pyloric canal was in significant positive correlation with the motility disturbance/adhesion score of the upper gastrointestinal series. The results of this study do not provide a firm basis for establishment of a causal relationship between cholecystectomy and the observed abnormalities, but we conclude that they point to morphologic and functional lesions in the postcholecystectomy patient which form a complex that most logically is explained by the occurrence of gastroduodenal adhesion-related and gastroduodenal motility disturbance-related reflux disease.

Key Words:

• Cholecystectomy
• gastric ulcer
• motility disturbances
• pyloric muscle