Background and study aims: Postcholecytectomy syndrome (PCS) (i.e. postprandial RUQ or epigastrial pain and fatty food intolerance) in patients with normal sphincter of Oddi (SO) motility is difficult to explain. The aim of the present study was to compare the results of antroduodenal manometry (ADM) in patients having normal and abnormal endoscopic SO manometry (ESOM).
Patients and methods: 12 patients (2 male, 10 female, mean age: 51.2 years) with PCS underwent ADM and ESOM during the same week. 6 of the 12 patients had elevated SO basal pressure i.e. SO dysfunction (SOD pos. group), while the remaining 6 patients had normal SO motility on ESOM (SOD neg. group). Biliary pain and dysmotility like dyspeptic symptoms (early satiety, bloating, nausea and vomiting) were assessed independently with our previously validated questionnaires. Antro-duodenal manometry was recorded with a 6 channel Synectic perfusion system during 24h period, with one caloric meal at lunch. Both interdigestive and postprandial recordings were analysed.
Results: All but one patient had normal interdigestive ADM motility pattern, both in the antrum and the duodenum. In the SOD pos. group only one patient (17%), while in the SOD neg. group 5 patients (83%) had postprandial antral hypomotility on ADM (abnormally low motility index). Interestingly, analysis of the questionnaires demonstrated that from the 6 of 12 PCS patients who had predominant dyspepsia (associated with biliary pain), 4 of them had abnormal ESOM, but only one had abnormal ADM.
Conclusions: Total gastroparesis or postprandial antral hypomotility is a frequent abnormality in PCS patients without SO dysmotility, which might explain postprandial symptoms, but not associated with predominant dyspepsia.
