Dyspepsia—How Noisy Are Gallstones? A Meta-Analysis of Epidemiologic Studies of Biliary Pain, Dyspeptic Symptoms, and Food Intolerance

Abstract

Background: In contrast to earlier beliefs, it is nowadays assumed that no relation exists between dyspeptic symptoms and the presence of gallstones. Although many studies indeed failed to show a relation, each has been too small to exclude it. The aim of this meta-analysis is to systematically review epidemiologic studies and to synthesize the data. Methods: Twenty-one controlled studies on the association between gallstones and dyspeptic symptoms were analyzed after critical appraisal with regard to selection bias, blinding, confounding, and data presentation. Most of them had reasonable validity. Inconsistencies between results of the studies could not be explained by differences in study design or validity. There was a slight indication of publication bias. Results: Upper abdominal pain was consistently associated with gallstones (pooled odds ratios, about 2.0), with no preference for the right side. The findings on biliary pain were inconsistent. The results exclude with reasonable certainty an association between gallstones and ‘classical’ dyspeptic symptoms such as flatulence, heartburn, and acid regurgitation, bloating, and belching. An exception was nausea and vomiting (odds ratio, 1.4). Unspecified food intolerance was related to gallstones, but fat intolerance was not. Conclusions: We conclude that it is not sensible to call dyspeptic symptoms ‘gallstone dyspepsia’, since component symptoms do not show a consistent relation with gallstones, and their diagnostic meaning over and above abdominal pain has not been evaluated.

Key Words:

• Abdominal pain
• biliary pain
• cholelithiasis
• diagnosis
• digestive symptoms
• dyspepsia
• epidemiology
• food intolerance
• meta-analysis