Gallstone disease

Abstract

Most epidemiological studies, aimed at estimating gallstone prevalence and incidence rates, do not represent the general population. Until recently, data were mainly derived from autopsy studies (which were often subject to selection bias) and cholecystectomy rates (which fluctuate as much as fivefold between, different countries and periods of time) [1]. At present, accurate data from sonographic screening studies regarding prevalence of cholelithiasis, are available for Western Europe and US. The median prevalence ranges from 5.9% (Chianciano, Italy) to 21.9% (Bergen, Norway) in European studies [2]. In US, the NHANES III study [3] indicated an age standardised prevalence of gallstones higher among Mexican Americans (8.9% and 26.7% in males and females respectively). In populations of Native American ancestry, the prevalence of gallstone disease is high (30-70%) and very high incidence of gallstones has also been reported in certain ethnic groups like Pima-Indians in Arizona (more than 70% of Pima women over 25 years of age had gallstones or a history of cholecystectomy) and Mapuche Indians in Chile. In Santiago, Chile, gallstone prevalence was found to be as high as 14.5% for males and 37.4% for females [1]. On the other hand, the lowest cholesterol gallstone prevalence rates (<5%) were recorded among Asian and African populations. In almost all sonographic surveys, gallstones are more frequent in women than in men and the majority of individuals were unaware of having gallstones. Gallstones may remain silent (asymptomatic) for a certain period of time or they can produce biliary pain by transient obstruction of the cystic duct. Furthermore, complications related to cholelithiasis may develop in some individuals, namely acute cholecystitis (including hydrop and empyema of gallbladder), choledocholithiasis with or without jaundice or cholangitis, gallstone pancreatitis, gallstone ileus, Bouveret's syndrome, and even gallbladder carcinoma. © 2006 Springer-Verlag/Wien.