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Gallstone disease: Population based studies on risk factors, symptomatology and complications
Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background & aims: Gallstone disease is common, costly and its complications are sometimes life threatening. The aim of this thesis is to determine the prevalence and incidence in relation to putative risk factors in the general population. Furthermore, to identify individuals with asymptomatic gallstones who are at risk of developing complications and, finally, to identify those who are at risk of an unsatisfactory outcome after cholecystectomy.

Material & methods: A sample of the adult (35-85 y.) general population was screened with ultrasound examination, blood tests and a questionnaire regarding digestive symptoms, life-style and quality of life. After excluding 115 subjects, who previously had a cholecystectomy, 739 participated. The examination was repeated after a minimum of five years. The individuals who were shown to have gallstones were followed in order to identify risk factors for developing complications. 200 consecutive symptomatic patients were operated with cholecystectomy on defined indications. They completed a questionnaire regarding digestive symptoms, life-style and quality of life before and three and twelve months after surgery.

Results: The crude prevalence of gallstone disease was 17.2 % for women and 12.4% for men. It increased with age and was higher among women. Symptoms did not differ between subjects with and without gallstones, but those previously operated with cholecystectomy did worse both regarding symptoms and quality of life. The estimated crude annual gallstone incidence was 1.5%. This increased with age, but did not differ between the sexes. Gallstone development was positively related to elevated blood lipids and negatively related to alcohol consumption. Fourteen of 120 subjects with gallstones at the primary screening developed a complication demanding treatment during a follow-up interval of 87 (3-146) months. In the patient series operated on strict indications, 91.3 % of those who had reported typical gallstone related pain preoperatively, experienced total or partial pain relief 3 months postoperatively. With atypical pain preoperatively, the corresponding figure was 77.1 %. The findings 12 months postoperatively were similar. In the logistic regression analysis, young age, frequency of pain episodes, atypical pain, specific food intolerance and disturbing abdominal gas were positively related to the frequency of abdominal pain 12 months after surgery.

Conclusion: The prevalence of gallstones was positively related to age and female gender. Previous cholecystectomy was associated with more symptoms and worse quality of life. The annual gallstone incidence of 1.5 % was high in comparison with other studies, but our population was older. In general, neither prevalent nor incident gallstones in the general population were associated with specific symptoms. The cumulative risk of developing a complication to gallstone disease during a 5-year followup interval was 7.6 % with no tendency to level off.

Patients with typical pain had a better outcome after cholecystectomy. Young age, atypical pain and frequent pain episodes before surgery were major risk factors for a worse outcome in terms of persistent pain.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2008. , 69 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1065
Keyword [en]
Epidemiology, gallstone disease, symptomatology, complications, risk factors
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-11801ISBN: 978-91-7393-896-9 (print)OAI: oai:DiVA.org:liu-11801DiVA: diva2:18224
Public defence
2008-05-28, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2015-11-19
List of papers
1. Prevalence of gallstone disease in a Swedish population sample: Relations to occuption, childbirth, health status, life style, medications and blood lipids
Open this publication in new window or tab >>Prevalence of gallstone disease in a Swedish population sample: Relations to occuption, childbirth, health status, life style, medications and blood lipids
Show others...
1998 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 33, no 11, 1219-1225 p.Article in journal (Refereed) Published
Abstract [en]

Background: There are only a few Swedish studies on the prevalence of gallstone disease in selected age groups, and none including possible risk factors. Methods: Of a population sample of 1200 individuals (age, 35-85 years), 857 participated in the study. The study subjects were asked to answer a questionnaire about potential risk factors (occupation, childbirth, life style, and so forth), symptoms, and quality of life. Cholecystectomy had previously been done in 115 subjects, leaving 742 for ultrasound examination of the gallbladder. Results: The prevalence of gallstone disease increased with age, and at 75 years or more, 53% of the women and 32% of the men either had gallstones or had previously undergone cholecystectomy (32% and 13%, respectively). When comparing subjects with and without gallstones, there were no differences with regard to any variable, including blood lipid levels. The odds ratio of previous cholecystectomy was increased in subjects with an occupation requiring no specific education and reduced in subjects using wine or spirits every week. The odds ratio of abdominal pain was increased after previous cholecystectomy. Women in this group also experienced a lower quality of life. Conclusions: The age and sex distribution of gallstone disease was in the order of the magnitude seen in other Scandinavian countries. None of the studied variables differed between subjects with and without gallstones. Subjects previously operated on with cholecystectomy did worse with regard to symptoms and quality of life.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13291 (URN)10.1080/00365529850172601 (DOI)
Available from: 2008-05-13 Created: 2008-05-13
2. Development of symptoms and complications in individuals with asymptomatic gallstones
Open this publication in new window or tab >>Development of symptoms and complications in individuals with asymptomatic gallstones
2004 (English)In: British Journal of Surgery, ISSN 0007-1323, Vol. 91, no 6, 734-738 p.Article in journal (Refereed) Published
Abstract [en]

Background: Gallbladder stones are common in the developed world. Complications of gallstones contribute substantially to healthcare costs and may be life threatening. The identification of individuals likely to develop complications would be of benefit in clinical practice as elective cholecystectomy could then be performed.

Methods: Seven hundred and thirty-nine subjects aged 35-85 years from the general population were screened for gallbladder problems by ultrasonography and questionnaire assessment of putative risk factors and digestive symptoms. Gallstones, cholesterolosis or sludge in the gallbladder were diagnosed in 123 (16·3 per cent) of 739 subjects, 120 of whom were followed for a median of 87 (range 3-146) months to May 2003 or until treatment was required.

Results: Fourteen patients were admitted to hospital and treated for gallstone-related complications or symptoms. The cumulative risk of being treated during the first 5 years after detection of asymptomatic gallstones was 7·6 per cent and there was no indication of this risk levelling off. There were no significant differences between treated and untreated subjects with regard to digestive symptoms or any of the risk factors monitored at the initial screening, although treated subjects were significantly younger than those who were not treated.

Conclusion: Nearly one in ten individuals with asymptomatic gallbladder stones in the general population may be expected to develop symptoms or complications that require treatment within 5 years. Age may be inversely related to the incidence of complications.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13292 (URN)10.1002/bjs.4547 (DOI)
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2009-08-18
3. Incidence of gallstone disease in a general population sample: relations to symptomatology and potential risk factors
Open this publication in new window or tab >>Incidence of gallstone disease in a general population sample: relations to symptomatology and potential risk factors
2008 (English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13293 (URN)
Available from: 2008-05-13 Created: 2008-05-13
4. Defined indications for elective cholcystectomy for gallstone disease
Open this publication in new window or tab >>Defined indications for elective cholcystectomy for gallstone disease
2008 (English)In: British Journal of Surgery, ISSN 0007-1323, Vol. 95, no 5, 620-626 p.Article in journal (Refereed) Published
Abstract [en]

Background: This study examined symptomatology and quality of life following elective cholecystectomy for symptomatic gallstone disease with defined indications for surgery.

Methods: In this prospective study of 200 consecutive patients (161 women; median age 46·5 (range 24-79) years), strict indications for elective cholecystectomy were stipulated. Digestive symptoms and quality of life were recorded with a self-administered questionnaire before and at 3 and 12 months after surgery.

Results: Of 149 patients who experienced abdominal pain with typical location before surgery, 136 (91·3 per cent) reported total remission or reduced frequency of that type of pain 12 months later. Of 35 patients who reported atypical or multiple pain location before operation, 27 (77 per cent) experienced reduced frequency or disappearance of that type of pain. Frequency of pain episodes, atypical or multiple pain location, specific food intolerance and frequency of disturbing abdominal gas at baseline correlated positively with the frequency of abdominal pain episodes at 12 months after surgery. There was a tendency towards an inverse relation to age.

Conclusion: The frequency of persistent abdominal pain after elective cholecystectomy was low among patients with typical pain location before surgery. Atypical pain location, and frequent pain episodes before operation significantly reduced the chance of becoming pain-free.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13294 (URN)10.1002/bjs.6020 (DOI)
Available from: 2008-05-13 Created: 2008-05-13 Last updated: 2009-08-18Bibliographically approved

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