Differential diagnosis and treatment of post-gastrectomy syndrome and biliary tract diseases (Biliary Dyskinesia: Post-Cholecystectomy Syndrome)

Post-Gastrectomy Syndrome (PGS) and Post-Cholecystectomy Syndrome (PCS) represent complex, chronic morbidities following major upper gastrointestinal surgery. The critical challenge in management lies in accurate differential diagnosis, as PGS primarily stems from surgically induced motility disturbances (e.g., rapid gastric emptying/Dumping Syndrome, delayed emptying, or mechanical obstruction/Afferent Loop Syndrome) and resulting nutritional deficiencies.1 Conversely, PCS is a heterogeneous entity requiring systematic exclusion of structural biliary disease (e.g., retained stones) before diagnosing functional disorders like Biliary Dyskinesia or Sphincter of Oddi Dysfunction (SOD).4 Treatment follows a stratified approach: PGS management centers on prolonged dietary modification, targeted pharmacotherapy (Octreotide, Acarbose), and reconstructive surgery (Roux-en-Y conversion) for refractory cases.1 PCS management focuses on addressing specific etiologies, ranging from bile acid sequestrants for diarrhea to endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy for confirmed obstructive SOD (Type I/II).8 Category III SOD, lacking objective findings, is managed medically, acknowledging its basis in visceral hypersensitivity.1 The divergence in etiology—gastric motility vs. biliary flow—dictates distinct diagnostic algorithms and definitive therapeutic strategies.