• Judith J de Jong, Carmen S S Latenstein, Djamila Boerma, Eric J Hazebroek, David Hirsch, Joost T Heikens, Joop Konsten, Fatih Polat, Marten A Lantinga, van LaarhovenCornelis J H MCJHMDepartment of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands., DrenthJoost P HJPHDepartment of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands., and Philip R de Reuver.
• Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
• Ann. Surg. 2022 Jun 1; 275 (6): e766-e772.

ObjectiveTo determine the prevalence of FD and IBS in patients eligible for cholecystectomy and to investigate the association between presence of FD/ IBS and resolution of biliary colic and a pain-free state.Summary Background DataMore than 30% of patients with symptomatic cholecystolithiasis reports persisting pain postcholecystectomy. Coexistence of FD/IBS may contribute to this unsatisfactory outcome.MethodsWe conducted a multicenter, prospective, observational study (PERFECT-trial). Patients ≥18 years with abdominal pain and gallstones were included at 5 surgical outpatient clinics between 01/2018 and 04/2019. Follow-up was 6 months. Primary outcomes were prevalence of FD/IBS, and the difference between resolution of biliary colic and pain-free state in patients with and without FD/IBS. FD/IBS was defined by the Rome IV criteria, biliary colic by the Rome III criteria, and pain-free by an Izbicki Pain Score ≤10 and visual analogue scale ≤4.ResultsWe included 401 patients with abdominal pain and gallstones (assumed eligible for cholecystectomy), mean age 52 years, 76% females. Of these, 34.9% fulfilled criteria for FD/IBS. 64.1% fulfilled criteria for biliary colic and 74.9% underwent cholecystectomy, with similar operation rates in patients with and without FD/IBS. Postcholecystectomy, 6.1% of patients fulfilled criteria for biliary colic, with no significant difference between those with and without FD/IBS at baseline (4.9% vs 8.6%, P = 0.22). Of all patients, 56.8% was pain-free after cholecystectomy, 40.7% of FD/IBS-group vs 64.4% of no FD/IBS-group, P < 0.001.ConclusionsOne third of patients eligible for cholecystectomy fulfil criteria for FD/IBS. Biliary colic is reported by only a few patients postcholecys-tectomy, whereas nonbiliary abdominal pain persists in >40%, particularly in those with FD/IBS precholecystectomy. Clinicians should take these symptom-dependent outcomes into account in their shared decision-making process.Trial RegistrationThe Netherlands Trial Register NTR-7307. Registered on 18 June 2018.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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