Brief Article
Copyright ©2012 Baishideng Publishing Group Co.
World J Gastroenterol. Mar 28, 2012; 18(12): 1365-1372
Published online Mar 28, 2012. doi: 10.3748/wjg.v18.i12.1365
Table 1 Assessment of functional abdominal symptoms (functional gastrointestinal disorder)
Intolerance to food
Acid regurgitation
Difficulty swallowing, food sticking in the lower esophagus
Loss of appetite (anorexia)
Feeling full after eating very little (early satiety)
Feeling of abdominal fullness or bloating
Abdominal distension, which requires loosening of the belt
Frequent loose bowel movements (or more often than usual)
Constipation (or less bowel movements than usual)
Alternating constipation and loose bowel movements
Difficulty passing stools with straining, urgency or feeling of incomplete evacuation
Abdominal pain or discomfort is relieved by bowel movements (passing of stool)
Table 2 Assessment of pain symptoms
Had an abdominal pain attack at least once for the last 3 mo or longer?
Experienced either pain or discomfort in the abdomen of a continuous steady nature at least once per week for the last 3 mo or longer?
For women: Did the onset of pain begin during pregnancy or soon after pregnancy?
Evaluated in the Emergency Department or seek medical attention for the abdominal pain?
Admitted to the hospital for the abdominal pain?
Estimate how often pain medications are required for the pain:
Not at all or rarely (less than 10% of the episodes)
Occasionally (less than 50% o the episodes)
Very often (more than 50% of the episodes)
Almost always (more than 80% of the episodes)
Time-interval during which the pain most often occurs:
7 am – 12 pm
12 pm – 6 pm
6 pm – 11 pm
11 pm – 7 am
Highly variable and unable to predict time of onset
Rate how often the pain occurs in the following abdominal areas:
Right upper quadrant1
Left upper quadrant1
Right lower quadrant1
Left lower quadrant1
Midline or center of the upper abdomen1
Is there often an area where the pain is strongest (able to point with one or two fingers):
Right upper quadrant
Left upper quadrant
Right lower quadrant
Left lower quadrant
Midline or center of the upper abdomen
Highly variable and unable to predict one area
Experience discomfort in the right upper quadrant when bending forward?
Abdominal pain radiates from where it started?
If yes, where does it radiate most often?
Right upper back beneath the right shoulder blade
Upper back between the shoulder blades
Lower back
None of these places mentioned
Highly variable and unable to predict a dominant area
Estimate the number of pain attacks over the last 3 mo
Estimate the usual duration of a pain attack in hours and minutes
Experience urge to move around during a pain attack1
Choose one of four patterns describing pain attacks (depicted by graphs):
Low-grade warning pain followed by a steady rise to a maximal constant pain, gradually getting better after a while
Low-grade warning pain followed by a steady rise to a maximal degree with occasional waves of pain, gradually getting better after a while
Pain begins suddenly with maximal intensity and improves over time
Pain begins suddenly with maximal intensity and persists with waves of pain until it goes away
Rate level of maximal pain intensity by 100 mm visual analogue scale score-scale
Table 3 Assignment of a clinical gallstone symptom score to different preoperative symptom frequency groups (%)
Percent of patients with symptoms according to pain presentation
Pain in upper abdomen: Pain most common in right upper quadrant or intensifies when bending forward or lying on the right side210096.694.188.2
Pain attacks commonly last more than one hour173.066.776.546.2
Pain in a ”plateau fashion”162.272.967.664.3
Urge to move during pain attacks151.469.058.884.6
Pain commonly occurs at night143.
Pain radiation to the back140.547.538.258.8
Nausea during pain attacks161.148.352.950.0
Use of analgesics in > 50% of pain attacks154.054.344.141.2
Perspiration during pain attacks136.141.441.260.0
Table 4 Demographics of the study population of 153 patients and 115 follow-up responders n (%), mean age (range, yr)
Symptom frequency groupFemalesMalesTotal
All groups122 (79.7), 47 (17-81)31 (20.3), 51 (28-85)153 (100), 48 (17-85)
Severe disease31, 45 (17-81)6, 44 (25-64)37 (24.2), 45 (17-81)
Moderate disease47, 44 (20-72)12, 53 (39-70)59 (38.6), 46 (20-72)
Mild disease26, 53 (25-78)8, 52 (34-85)34 (22.2), 53 (25-85)
Chronic disease18, 53 (23-81)5, 55 (30-80)23 (15.0), 54 (23-81)
Responders to follow-up89 (77.4), 49 (20-81)26 (22.6), 52 (25-85)115 (75.2), 50 (20-85)
Table 5 Changes in gallstone severity score by symptom frequency group in 115 responding patients from the study population of 153 patients n (%)
Preoperative SFGPatientsPreoperative
mean % reduction in GSS
mean GSSmean VASmean GSSmean VAS
Severe disease37 (24.2)6.1181.129 (78.4)1.7633.069.1
Moderate disease59 (38.6)6.4786.641 (69.5)1.3215.878.7
Mild disease34 (22.2)6.0981.326 (76.5)1.0412.887.0
Chronic disease23 (15.0)4.3576.819 (82.6)1.008.962.7
Table 6 Symptomatic improvement in 115 patients after cholecystectomy n (%)
Asymptomatic but improvedSymptomatic or worseUnchangedP value1
All patients76 (66.1)28 (24.3)11 (9.6)
Severe disease15 (51.7)10 (34.5)4 (13.7)
Moderate disease27 (65.8)9 (22.0)5 (12.2)
Mild disease20 (76.9)5 (19.2)1 (3.9)
Chronic disease14 (73.7)4 (21.0)1 (5.3)
< 6054 (64.3)23 (27.4)7 (8.4)
> 6022 (71.0)5 (16.1)4 (12.9)
Women56 (62.9)24 (27.0)9 (10.1)
Men20 (76.9)4 (15.4)2 (7.7)
Table 7 Presence of pre- and post-operative functional gastrointestinal disorder in 115 patients with different n (%)
Presence of FGIDPatientsAsymptomaticSymptomatic, improvedUnchanged or worseP value1
None pre-operative13 (11.3)11 (84.6)2 (15.4)0
Present pre-operative102 (88.7)65 (63.7)26 (25.5)11 (10.8)0.449
None post-operative49 (42.6)42 (85.7)7 (14.3)0
Present post-operative66 (57.4)34 (51.5)21 (31.8)11 (16.7)0.001
Total115 (100)76 (66.1)28 (24.3)11 (9.6)