Cholecystectomy and gallstone dyspepsia. Clinical and physiological study of a symptom complex.

The symptom complex of gallstone dyspepsia is defined and then analysed before and after cholecystectomy in 108 patients. Only 46% of patients were symptom-free after operation and 30% were no better. When pyloric function was studied patients with these symptoms before or after cholecystectomy and those with normal radiographs showed duodenogastric reflux, often precipitated by intraduodenal fat. Symptomless matched control subjects showed no reflux. Synchronous radiology and pressure recordings demonstrated that the pylorus in these patients failed to contract in response to a duodenal contraction, whereas the normal pylorus could prevent the reflux produced by an isolated duodenal contraction. The effect of metoclopramide on gastroduodenal contractions and in treating the symptoms was assessed. Gallstone dyspepsia is essentially a functional disease--a disorder of gastroduodenal motility.