Date of Award

2012

Document type

Thesis

Degree Name

MD (Medical Doctor)

First Supervisor

Professor Thomas N. Walsh

Keywords

Gastric Mucosa, Cholecystectomy

Abstract

Chronic exposure of oesophageal mucosa to bile has been implicated in the etiology of the oesophageal lesions which develop into Barrett's oesophagus.Loss of the gallbladder reservoir function at cholecystectomy may critically alter the dynamics of bile storage and release.

In our first study we aimed to investigate the prevalence of bile reflux in three patient populations; symptomatic controls, Barrett's patients and patients post oesophago-gastric resection for carcinoma. Augmentation of bile reflux was noted in patients who had previous history of cholecystectomy. A high proportion of patients remained symptomatic post-cholecystectomy and a high proportion of these still-symptomatic post-cholecystectomy patients had increased bile reflux index.

In our second retrospective study we examined the effects of cholecystectomy on gastric and oesophageal mucosa at molecular and histological level. There was an increase in bile reflux index, Ki67 and p53 in post-cholecystectomy patients. This raised concern about development of pre-malignant changes in these patients.

In the third study, the effect of cholecystectomy on gastric and oesophageal microenvironment was evaluated prospectively. This study noted the histological and molecular changes precipitated by cholecystectomy are similar to those identified as precursors of Barrett's oesophagus. Such concerning changes suggest that options other than cholecystectomy be considered for patients with gallstones in a functioning gallbladder.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License.

File Size

3,410 KB

Comments

Submitted for the Award of Doctor of Medicine to the Royal College of Surgeons in Ireland, 2012.

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