EPIDEMIOLOGICAL AND PATHOLOGICAL STUDIES OF GALLSTONE DISEASE IN PATIENTS OF LUCKNOW REGION
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 20
Abstract
BACKGROUND Gallstone disease is the most common gastrointestinal problem associated with gallbladder affecting millions of people throughout the world. The gallstones are solid crystalline precipitates in the biliary tract, usually formed in the gallbladder. Cholesterol and calcium bilirubinate are the two main substances involved in gallstone formation. Based on their chemical composition, gallstones are classified as cholesterol, pigment and mixed stones.(1) The colour of gallstones may be white, yellow, brown, black and green. Cholesterol stones are usually yellow, but are sometimes white in colour. Mixed stones are usually smaller, multiple in numbers and occur in various colours and shapes. Pigment gallstone may be brown or black, which mainly consists of bilirubin and calcium salts such as calcium carbonate.(2) The incidence of this disease shows substantial geographical variation with higher incidence in North Indian people as compared to South Indian people.(3) Dietary habits and lifestyle of the patient are going to influence the formation of gallstone.(4) High biliary protein and lipid concentration are risk factors for the formation of gallstones, while gallbladder sludge is thought to be usual precursor of gallstone formation. Age, gender and ethnicity are the most important factors predisposing its prevalence in population.(5) Gallstone disease is related to several cardiometabolic risk factors such as obesity, dyslipidaemias (Hypertriglyceridaemia and low-high-density lipoprotein and high cholesterol), diabetes, unhealthy diet and sedentary lifestyle. High-risk factor for the cholesterol dominant gallstones is the obese individuals with a body mass index of 30 kg/sq. metre.(6) People with diabetes are at higher risk for gallstone disease and gallbladder disease may progress more rapidly in patients with diabetes who are obese and tend to have infection.(7) This study was aimed to confirm the prevalence of various types of gallstones in rural population of Lucknow region with concern to most common age group and sex including common clinical features manifested during the course of the disease. MATERIALS AND METHODS This study is a retrospective descriptive study, which included 132 patients over a period of 18 months (from July 2015 to December 2016) with diagnosis based on abdominal ultrasound report and further confirmed by biochemical test. Detailed history of all patients was taken with reference to dietary habits, age, sex and metabolic diseases (Diabetes) and lab reports from MR department. These cases were systematised to find out the cumulative prevalence rate of gallstone disease among rural population of Lucknow region, because TSM Hospital caters services mostly to rural patient. Previous records of abdominal ultrasound were reviewed, which were available in MR department of hospital during July 2015 to December 2016. Data was tabulated separately and cases for positive and negative for gallstones disease were identified and gallstones of patients available in pathology department were further analysed with chemical and enzymatic methods for knowing types of gallstones prevalent in this area. RESULTS A total of 132 patients with gallstone disease were diagnosed by abdominal ultrasound. The most interesting finding of this present study was that gallstone disease was more common in females (79.54%) as compared to males (20.45%) in ratio of female-to-male as 3.88: 1. The age of cases was considered from newborn to 70 years. The observations were grouped after every 10 years interval. In 0 - 10 age group, 1 (0.75%) case of gallstone disease was reported. Maximum cases (43.94%) were reported in 41 - 50 age group. We noticed 2 (1.5%) cases in 11 - 20 age group, 17 (12.8%) cases in 21 - 30 age group, 30 (22.73%) in 31 - 40 age group, 20 (15.15%) in 51 - 60 age group and 4 (3.03%) in 61 - 70 age group. The disease has huge incidence in the age group of 41 - 50 years. The common complication was flatulence (64), dyspepsia (63), epigastric pain (49) and pain in right hypochondrium (47) and 37 patients had complaints of nausea also. The biliary calculi collected from 132 patients were divided into 3 groups based on their colour: Cholesterol calculi, Mixed calculi and Pigment calculi. Out of 132 stones 50 (37.87%) were cholesterol, 47 (35.60%) were mixed stone and 35 (26.51%) were pigment stone indicating incidence of gallstones in the studied population from this area as Cholesterol stone > mixed stone > pigment stone. 18 out of 132 were known diabetics under this study. This reflects association of metabolic disease (Diabetes) with gallstone disease in Indian population. CONCLUSION Gallstone disease is more prevalent in female patients and has higher incidence as compared to male patient. Gallstone disease is more common in 41 to 50 years’ age group. The most common type of gallstones was found to be cholesterol type of gallstone followed by mixed and pigment gallstone. In spite of numerous well-defined risk factors for gallstone, global epidemic of obesity and metabolic syndrome will probably increase incidence of gallstone disease in population.
Authors and Affiliations
Abha Misra, Ritu Sharma, Manaswi Chaubey, Rajesh Kr. Chaturvedi
Keywords
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- EP ID EP431416
- DOI 10.14260/jemds/2018/561
- Views 99
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