Does Cholecystectomy Increase the Esophageal Alkaline Reflux? Evaluation by Impedance-pH Technique
Condition: Cholecystolithiasis; Cholecystectomy; Gastroesophageal Reflux
MeSH terms: Gastroesophageal Reflux; Cholecystolithiasis; Cholelithiasis; Gallstones
Study type: Interventional

Summary: 
      Publications with different conclusions are available with regard to the correlations between
      the cholecystolithiasis, cholecystectomy and gastroesophageal reflux disease (GERD). In this
      study, the controversial relationship between cholecystolithiasis, cholecystectomy and GERD
      is discussed through the impedance pH method which started to be used in recent years, a
      method indicating the gas and liquid (acid and non-acid) gastroesophageal reflux (GER) and
      esophageal clearance time.
    

Detailed description: 
      Gallstones are observed among 6-20% of the people in the world and 2 folds in women than in
      men. The symptomatic treatment of the cholecystolithiasis is the cholecystectomy and it is
      known that every year in United States of America (USA) more than 750.000 cholecystectomy
      operations are performed. Usually applied to laparoscopic surgery, in experienced hands with
      great success, but the application is not without problems and can cause the condition called
      postcholecystectomy syndrome. Postcholecystectomy syndrome is a heterogeneous condition and
      may occur depending on many causes. One of the suggested reasons is the increasing
      gastroesophageal reflux diseases (GER). Publications indicating the increase of GER after
      cholecystectomy are available.

      Relationship between the gallbladder stone and the reflux; whether reflux increases after
      cholecystectomy is a controversial subject. In current studies, the assessments of reflux are
      performed by different techniques such as interview, endoscopy and 24-hour pH monitoring.
      These evaluations are often useful in detecting acid reflux. Whereas it is known that after
      cholecystectomy alkaline bile reflux may be determined in stomach. Therefore, the
      determination of bile reflux in esophagus after cholecystectomy is also possible. This
      situation may be important in terms of esophagus adenocarcinoma, because the esophagus
      adenocarcinoma generally develops in the basis of Barrett's esophagus and alkaline reflux is
      accepted to contribute to developing Barrett's esophagus (13).

      Bile reflux into the stomach is reported in a rate of 30-100% after stomach surgery and
      80-90% after gallbladder surgery. Even though bile reflux is observed in such a high
      percentage, not every kind bile reflux will damage the gastric and esophageal mucosa. Leaking
      up into the stomach (reflux), the bile and pancreatic secretions presented in the duodenum
      content mix up with the hydrochloric acid and pepsin presented in stomach, and thereby damage
      occurs in the gastric and esophageal mucosa. The continuation of this interaction may develop
      gastritis, esophagitis.

      The increase of alkaline reflux and its importance are known in the development of Barrett's
      esophagus, which is a component of GER spectrum and which can develop into adenocarcinoma. As
      a result of research performed on people with cholecystectomy, the risk of developing
      esophageal cancer has been shown to increase moderately. This is probably duo to the reflux
      of the bile found in the duodenum content through the esophagus. Nowadays only acid reflux
      can be determined by the widely used 24-hour pH-meter. The bile-sensitive Bilitec is a
      difficult method to implement and it is not widely used. Impedance-pH is a recently developed
      technique used to monitor all kinds of reflux (gas, liquid, acides and non-acides), reflux
      level and the clearance period of the esophagus.

      The purpose of this study: To investigate the relationship between GER, cholecystolithiasis
      and cholecystectomy by using the Impedance-pH method.
    

Intervention name(s): impedance pH measurement
Intervention type(s): Procedure
Intervention description(s): Impedance pH measurement: Impedance-pH is a recently developed technique used to monitor all kinds of reflux (gas, liquid, acides and non-acides), reflux level and the clearance period of the esophagus.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: cholecystolithiasis; cholecystectomy; gastroesophageal reflux; impedance pH; The relationship between cholecystolithiasis, cholecystectomy and gastroesophageal reflux by impedance pH-method.