Liver, Pancreas and Biliary Tractbethanechol (cas 111244-96-3) provocation testing does not predict symptom relief after cholecystectomy for acalculous biliary pain

Add time:08/31/2019    Source:sciencedirect.com

Background. The currently accepted hypothesis to explain acalculous gallbladder pain is the lack of contractile co-ordination between the body and neck. We have previously shown that bethanechol, a muscarinic stimulant causes differential stimulation of these two regions.Aim. To evaluate the reliability of bethanechol-induced gallbladder contraction in predicting symptom relief after cholecystectomy in patients with acalculous gallbladder disease.Methods. Fifty-one patients underwent a bethanechol provocation test together with serial ultrasound to determine gallbladder emptying. McGill pain questionnaires were completed, and patients positive for pain (bethanechol provocation test +ve) were offered cholecystectomy, and patients negative for pain (bethanechol provocation test −ve) were reassessed at 6 months and offered cholecystectomy if symptoms persisted. All patients answered pain questionnaires either 6 months after surgery or as follow-up.Results. There was no difference in the percentage of gallbladder emptying between the bethanechol provocation test +ve and bethanechol provocation test −ve groups. Fifty-three percent of bethanechol provocation test +ve patients and 54% of bethanechol provocation test −ve patients still remained symptomatic 6 months after surgery.Conclusion. Gallbladder pain provoked by bethanechol does not predict symptom relief after cholecystectomy.

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