Pain characteristics suggest higher benefit from gallbladder surgery

According to a new study in Clinical Gastroenterology and Hepatology, better understanding of a patient's abdominal pain could help physicians know which patients will benefit most from surgical removal of the gallbladder. Clinical Gastroenterology and Hepatology is the official journal of the American Gastroenterological Association.

Nearly 800,000 gallbladder removal surgeries, or cholecystectomies, are performed annually in the U.S. at a cost exceeding $6 billion. Surgeries are often performed on patients whose gallstones are discovered via imaging tests after patient complaints of abdominal pain. Considering that abdominal pain persists in up to 50 percent of patients after cholecystectomy, physicians need a better way to determine who will benefit from surgery.

"Given the number of cholecystectomies that are performed, this study underscores the importance of taking a detailed history when selecting patients for surgery," said Johnson L. Thistle, MD, of Mayo Clinic and lead author of this study. "About 80 percent of gallstones never become symptomatic. Identifying the features of episodic gallbladder pain and differentiating them from symptoms of gastroesophageal reflux disease and irritable bowel syndrome should lead to improved symptom relief and value for patients with abdominal pain."

Researchers prospectively studied 1,008 patients with upper abdominal pain who had elective cholecystectomy for uncomplicated gallstone disease. The following pain characteristics, especially if multiple, were most predictive of pain relief after surgery: episodic pain (usually once a month or less), lasting 30 minutes to 24 hours, occurring during the evening or at night, and onset one year or less before presentation.

Gallstones form in the gallbladder and are composed predominately of cholesterol, which has separated out of solution in bile and formed crystals, much as sugar may form in the bottom of a syrup jar. Gallstones may be as small as a grain of sand or as large as a golf ball, and the gallbladder may contain anywhere from one stone to hundreds. It is not entirely known why some people develop gallstones and others do not.

Many people with gallstones have no symptoms, and often, the gallstones are found when tests are performed to evaluate other problems. In this case, no treatment is usually recommended. When symptoms do arise, gallbladder removal is the most widely used therapy.