[Cholelithiasis associated with upper gastrointestinal pathology. Critical evaluation of the emerging incidence and diagnostic and therapeutic indications].

Although cases of upper G.E. tract diseases associated with simple cholelithiasis are described as specific syndromes in the literature (Saint's triad, Casten's syndrome, etc.) they may be usefully evaluated with the aim of checking the following parameters: a) incidence and importance of associated pathologies; b) etio-pathogenetic correlation between age, sex and incidence; c) clinical extent of the disease and factors determining choice of medical or surgical treatment; d) more specific presurgical diagnostic investigation for certain cases; e) effect of combined surgery on recovery. Recent research carried out (Choctaw) in which the term associated pathology was defined is described. A sample of 358 patients suffering from cholelithiasis was examined. Of these, 230 were suitable candidates for surgery and systemic presurgical examination by means of digestive tract X-ray investigation and fecal blood tests. 35% of cases were found to be associated pathologies including hiatal hernia, peptic ulcer, duodenal diverticula, gastric neoplasia and various diseases of the large intestine. These data were found to be statistically different from data collected from a similar group of patients complaining of abdominal colic who did not display symptoms of cholelithiasis although 17% had diseases of the upper G.E. tract. Combined surgery was carried out on 82% of patients and the subsequent follow-up period lasted for 1 to 3 years. A presurgical study programme aimed particularly at female patients over 50 was therefore designed. Post-surgical recovery was not affected by combined surgery.