Unveiling Hidden Culprits: An Observational Study of Upper Gastrointestinal Endoscopy Findings in Symptomatic Cholelithiasis Patients

Background: Cholelithiasis, commonly known as gallstone disease, is often managed surgically through cholecystectomy. However, many patients continue to experience persistent gastrointestinal symptoms post-surgery, raising questions about hidden upper GI pathologies that may mimic gallstone-related discomfort. Could these overlooked conditions be the true culprits behind lingering symptoms? Aim & Objectives: 1. to analyze the role of upper gastrointestinal endoscopy (UGIE) as a routine pre-operative investigation in cholelithiasis patients with typical biliary colic or atypical upper abdominal symptoms undergoing elective cholecystectomy.2.to find out co existing pathologies in symptomatic cholelithiasis patients. Methods: An observational study was conducted on 80 patients diagnosed with symptomatic cholelithiasis. All patients un derwent preoperative UGIE to assess for associated GI abnormalities. The findings were analyzed and correlated with symp tom presentation, demographic factors, and postoperative outcomes. Statistical Analysis: Descriptive statistics were used to analyze the prevalence of pathological upper gastrointestinal endos copy (UGIE) findings, including gastritis, hiatus hernia, peptic ulcer disease, polyps, and malignancy, expressed as percentages. Data were recorded and processed using Microsoft Excel for preliminary analysis. The Chi-square test was applied to assess the association between the type of pain (typical vs. atypical) and endoscopic findings. Statistical analysis was conducted us ing IBM SPSS Statistics (Version 27), with significance level set at 0.05 for all tests. Results: This prospective study was conducted at a tertiary care medical college hospital in Mangalore, Karnataka, India. It in cluded 80 patients diagnosed with gallbladder stones via ultrasound, who subsequently underwent upper gastrointestinal en doscopy (UGIE) to evaluate coexisting GI pathology. UGIE detected abnormalities in a significant proportion of patients, with gastritis being the most prevalent finding, followed by reflux esophagitis and peptic ulcer disease. A subset of patients tested positive for Helicobacter pylori infection. Notably, patients with abnormal UGIE findings had a higher incidence of persistent postoperative symptoms compared to those with normal UGIE results. The study observed a higher prevalence of gallstones in females compared to males, with a female-to-male ratio of 1:0.45. Gallstones were more commonly found in individuals over 40 years of age, with the majority of female patients being above 60 years. A subset of patients with inflammatory GI pathology tested positive on the rapid urease test and were treated with an H. pylori eradication regimen, leading to symptom improve ment. Furthermore, upper GI abnormalities were more frequently observed in patients with a single gallstone compared to those with multiple calculi. Additionally, all patients with a normal UGIE had a normal gallbladder wall thickness. This study highlights the importance of evaluating upper GI pathology in patients with gallstones to optimize management and improve postoperative outcomes. Conclusion: This study highlights the critical role of upper gastrointestinal endoscopy (UGIE) in the preoperative evaluation of symptomatic cholelithiasis. Findings suggest that gastrointestinal inflammatory conditions, rather than gallstones, are of ten the primary cause of symptoms. Laparoscopic cholecystectomy should be deferred until after GI treatment; if symptoms resolve, surgery may not be needed.