Invited Commentary

Commentary on "Cholecystectomy for Biliary Dyskinesia in Gastroparesis: Mimic or Misfortune?"

Authors: John W. Birk, MD, Donald Gullickson, MD

Abstract

Functional syndromes of the gastrointestinal tract can be challenging in both diagnosis and management. This is yet another example of the crossroads of art and science in medicine. Gastroparesis is a syndrome that can be objectively defined by delayed gastric emptying in the absence of mechanic obstruction.1 Gastroparesis also can be identified by a variety of clinical symptoms, including nausea, vomiting, bloating, early satiety, and upper abdominal pain.1 These symptoms can occur in many other disorders, however. Interestingly, pain has been characterized as a common presenting symptom of gastroparesis and present in up to 90% of patients in one study.2 Although pain may be a diagnostic feature of gastroparesis, it is the ongoing pain of this syndrome that may lead to ordering further diagnostic testing. This, in turn, can lead to an evaluation of other disease states that may lead the clinician astray.

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References

1. Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol 2013;108:18-37.
 
2. Cherian D, Sachdeva P, Fisher RS, et al. Abdominal pain is a frequent symptom of gastroparesis. Clin Gastroenterol Hepatol 2010;8:676-681.
 
3. Behar J, Corazziari E, Guelrud M, et al. Functional gallbladder and sphincter of oddi disorders. Gastroenterology 2006;130:1498-1509.
 
4. Nusrat S, Mahmood S, Kastens D, et al. Cholecystectomy for biliary dyskinesia in gastroparesis: mimic or misfortune? South Med J 2014;107:757-761.
 
5. Johnson JJ, Garwe T, Katseres N, et al. Preoperative symptom duration predicts success in relieving abdominal pain caused by biliary dyskinesia in a pediatric population. J Pediatr Surg 2013;48:796-800.
 
6. Veenstra BR, Deal RA, Redondo RE, et al. Long-term efficacy of laparoscopic cholecystectomy for the treatment of biliary dyskinesia. Am J Surg 2014;207:366-370.