Frequency of cholecystectomy and associated sociodemographic and clinical risk factors in the ELSA-Brasil study / Frequência de colecistectomia e fatores de risco sociodemográficos e clínicos associados no estudo ELSA-Brasil

ABSTRACT: CONTEXT AND OBJECTIVE: There are few data in the literature on the frequency of cholecystectomy in Brazil. The frequency of cholecystectomy and associated risk factors were evaluated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). DESIGN AND SETTING: Cross-sectional study using baseline data on 5061 participants in São Paulo. METHODS: The frequency of cholecystectomy and associated risk factors were evaluated over the first two years of follow-up of the study and over the course of life. A multivariate regression analysis was presented: odds ratio (OR) and 95% confidence interval (95% CI). RESULTS: A total of 4716 individuals (93.2%) with information about cholecystectomy were included. After two years of follow-up, 56 had undergone surgery (1.2%: 1.7% of the women; 0.6% of the men). A total of 188 participants underwent cholecystectomy during their lifetime. The risk factors associated with surgery after the two-year follow-up period were female sex (OR, 2.85; 95% CI, 1.53-5.32), indigenous ethnicity (OR, 2.1; 95% CI, 2.28-15.85) and body mass index (BMI) (OR, 1.10; 95% CI, 1.01-1.19 per 1 kg/m2 increase). The risk factors associated over the lifetime were age (OR, 1.03; 95% CI, 1.02-1.05 per one year increase), diabetes (OR, 1.92; 95% CI, 1.34-2.76) and previous bariatric surgery (OR, 5.37; 95% CI, 1.53-18.82). No association was found with parity or fertile age. CONCLUSION: Female sex and high BMI remained as associated risk factors while parity and fertile age lost significance. New factors such as bariatric surgery and indigenous ethnicity have gained importance in this country.

RESUMO CONTEXTO E OBJETIVO: Há escassez de dados na literatura sobre a frequência de colecistectomia no Brasil. Avaliou-se a frequência de colecistectomia e os fatores de risco associados no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). DESENHO E LOCAL: Estudo transversal com dados da linha de base de 5061 participantes em São Paulo. MÉTODOS: Avaliou-se a frequência de colecistectomia e fatores de risco associados nos dois primeiros anos de seguimento do estudo e ao longo da vida. Apresentou-se regressão logística [razão de chances (RC); intervalo de confiança de 95% (IC 95%)] multivariada. RESULTADOS: Um total de 4716 (93,2%) indivíduos com informação sobre colecistectomia foi incluído. Após 2 anos de seguimento, 56 participantes tinham sido operados (1,2%: 1,7% nas mulheres; 0,6% nos homens), totalizando 188 participantes com colecistectomia durante a vida. Os fatores de risco associados à cirurgia após dois dois anos de seguimento foram sexo feminino (RC, 2,85; IC 95%, 1,53-5,32), etnia indígena (RC, 2,1; IC 95%, 2,28-15,85) e índice de massa corpórea, IMC (RC, 1,10; IC 95%, 1,01-1,19 por aumento de 1 kg/m2); e, ao longo da vida: idade (RC, 1,03; IC 95%, 1,02-1,05 por um ano de aumento), diabetes (RC, 2,10; IC 95%, 1,34-2,76) e cirurgia bariátrica prévia (RC, 5.37; IC 95%, 1,53-18,82). Não se observou associação com paridade ou idade fértil. CONCLUSÃO: Sexo feminino e IMC elevado permanecem sendo fatores de risco associados à colecistectomia, mas paridade e idade fértil perderam significância. Novos fatores de risco, como cirurgia bariátrica prévia e etnia indígena, ganharam relevância no país.

Patrón de consumo alimentario en una muestra de adultos con Enfermedad Colelitiasica (EC)

En un estudio realizado en una muestra aleatoria de adultos de Rosario se encontró una tasa de prevalencia de Enfermedad Colelitiásica (EC) del 20,5%. Con el objetivo de determinar el patrón de consumo alimentario de estas personas y compararlo con las Raciones Dietéticas Recomendadas (RDA) se entrevistaron 44 de dichas personas con EC. Se les realizó una encuesta sobre hábitos alimentarios 5 años previos al diagnóstico, empleando un cuestionario semi-cuantitativo de frecuencia de consumo (FFQ) y un Atlas fotográfico de porciones estandarizadas. Se calcularon los promedios (± desvío estándar) de la edad, del Índice de Masa Corporal (IMC), del consumo de cada nutriente y de la energía total consumida (Kilocalorías). La significación estadística de las diferencias entre sexos se evaluó aplicando pruebas t de student. La edad de las personas estudiadas (18 varones y 26 mujeres) fue 63,8±13,8 años y el IMC fue 28,2±5,8. Consumos promedio diarios: Kcalorias 2941±791,1 ; Carbohidratos 295,3±96,9 g; Proteínas 131,6±36,8 g; Grasa 128,9± 43 g; Ácidos grasos saturados 41,9±18,6 g; Ácidos grasos poliinsaturados 13,8±8,7 g; Colesterol 455,4±186,8 mg; Sodio 2730±1552,1 mg; Potasio 2912,8±1001,4 mg; Calcio 719,3±403,3 mg; Hierro 16±4,6 mg; Fósforo 801,6±320,3 mg; Vitamina A 3121,7±1811,9 mcg; Vitamina B1 0,80±0,30 mg; Vitamina B2 1,9±0,8 mg; Vitamina C 157,6±114,1 mg; Niacina 6,9±2,7 mg; Fibra total 12± 5,3 g; Café 70,7±104,3 cc. Se concluye que el patrón alimentario de las personas con EC se caracterizó por un alto consumo de Grasas, Ácidos grasos saturados y Colesterol, no alcanzando las recomendaciones para Carbohidratos, Calcio, Niacina y Fibra.

Food intake pattern in a sample of adults with Gallbladder Disease (GD). In Rosario, Argentina, a 20,5% prevalence rate of Gallbladder Disease (GD) was found in a random sample of adults. The aim of this study was to determine the food consumption pattern of subjects with GD nested in that sample for further comparison with the Recommended Dietary Allowances (RDA). Forty-four subjects were interviewed about the food consumption during the five years before their diagnosis, by applying a semi-quantitative food frequency questionnaire (FFQ) and a photographic atlas of standardized portions. Age, body mass index (BMI), all consumed nutrients, and total energy intake (kilocalories) were reported as Mean ± standard deviation. Comparisons according to sex (18 males and 26 females) revealed no significant differences in the variables under analysis. Age and BMI in the overall sample were as follows 63.8±13.8 years and 28.2±5.8, respectively. Mean daily consumption of nutrients was as follows: Carbohydrates 295.3±96.9 g , Protein 131.6±36.8 g , Fat 128.9±43 g , Saturated fatty acids 41.9±18,6 g, Polyunsaturated fatty acids 13.8±8.7 g, Cholesterol 455.4±186.8 mg, Sodium 2730±1552.1 mg, Potassium 2912.8±1001.4 mg, Calcium 719.3±403.3 mg, Iron 16±4.6 mg, Phosphorus 801.6±320.3 mg, Vitamin A 3121.7±1811.9 mcg, Vitamin B1 0.80±0.30 mg, Vitamin B2 1.9±0.8 mg, Vitamin C 157.6±114.1 mg, Niacin 6.9±2.7 mg, Fiber 5.3±12 g, Coffee 70.7±104.3 cc (total energy intake 2941±791.1 Kcal). Subjects with GD have a history of higher intake of fat, saturated fatty acids and cholesterol with consumption of carbohydrates, calcium, niacin and fiber below the recommended quantities.

Prevalence and Risk Factors of Gallbladder Polyp in Adults Living in Daegu and Gyeongbuk Provinces / 대한소화기학회지

BACKGROUND/AIMS: Although there are various reports on the prevalence of gallbladder (GB) polyp according to the race or area, there is no report on Daegu and Gyeongbuk provinces. Therefore, we investigated the prevalence and related risk factors of GB polyp in health screening population of Daegu and Gyeongbuk provinces. METHODS: Of 28,911 adult health screening examinees from January 1997 to May 2003, age and gender-matched 8,008 (3,896 men, 4,112 women) were randomly selected to evaluate the prevalence. Independent risk factors were analyzed by comparing various variables between the GB polyp positive and negative groups. RESULTS: The prevalence of GB polyp was 2.2% (175/8,008). Those were 2.7% (104/3,896) among men and 1.7% (71/4,112) among women. Independent risk factors related with GB polyp were male gender (OR 1.434, p<0.001), obesity (OR 1.237, p=0.024), and hepatitis B carrier (OR 1.888, p<0.001) CONCLUSIONS: Prevalence of GB polyp in Daegu and Gyeongbuk provinces is 2.2%. Male, obesity, and hepatitis B carrier may be the risk factors related with GB polyp in this region.

Effect on gallbladder function subsequent to truncal vagotomy and gastrojejunostomy for chronic duodenal ulcer.

The effect of truncal vagotomy on gallbladder function and on the incidence of lithogenesis has remained controversial. A prospective and retrospective investigational study was undertaken to evaluate the effect of truncal vagotomy and gastrojejunostomy on gallbladder function. The study included a total of 76 patients and 77 controls. In Group I (Prospective group), 32 consecutive patients with chronic duodenal ulcer and gastric outlet obstruction undergoing truncal vagotomy and gastrojejunostomy were included. Group II included 25 age and gender matched controls (prospective group). Group III included 44 patients who had undergone truncal vagotomy and gastrojejunostomy 3 years or more prior to presentation (Retrospective group) and Group IV included 52 age and gender matched controls for the retrospective group. The patients in the prospective groups were followed up for a period of 1 year. An alkaline tide test was done in the prospective and retrospective group to assess for the completeness of vagotomy. Gallbladder contractile response to fatty meal and the presence of stones and sludge were noted in all the four groups by ultrasonography. There were 30 patients in the prospective group and 40 in the retrospective group after excluding patients with incomplete vagotomy. On ultrasound examination, there was no significant difference in the gallbladder volume and contractility of the study group when compared with the controls. Gallbladder sludge was found in 16 to 25% of patients in the prospective group (group I) during follow up, where as similar finding was documented in 8% of the matched control (group II (P>0.1). However, in the retrospective (group III) 10% (4 out of 40) had calculi and 20% of patients demonstrated sludge which was significantly higher when compared with the controls (p = 0.001). Truncal vagotomy and gastrojejunostomy did not affect gallbladder contractility, but it might predispose to the formation of sludge and subsequent calculi in a proportion of patients in long term.

Cholesterolosis: incidence, correlation with serum cholesterol level and the role of laparoscopic cholecystectomy

To report the incidence of cholesterolosis in the surgically removed gallbladders, its association with serum cholesterol level and to review the role of laparoscopic cholecystectomy in the treatment. This retrospective study included all patients who had consecutive cholecystectomies for various gallbladder disorders, performed by 2 consultants during a 5-year period from January 1997 through to December 2002, in the College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. The clinical records of those found to have cholesterolosis on histopathological examination were reviewed, and the data were analyzed for their age, sex, fasting serum cholesterol level and the final outcome of cholecystectomy. The study group was comprised of 549 patients and out of which, 74 [13.4%] had cholesterolosis of the gallbladder. There were 59 [79.9%] female and 15 [20.1%] male patients. Age ranged from 18-64-years with a mean of 35.7-years. Sixty-three [85.1%] cases were reported to have abnormally high fasting serum cholesterol levels [>=5.5 mmol/L], whereas 11 [14.9%] had normal serum cholesterol level. Cholesterolosis with coexistent gallstones was documented in 47 [63.3%] patients while 27 [36.5%] subjects showed acalculous cholesterolosis. Laparoscopic cholecystectomy was performed in 71 [95.9%] individuals, whereas 3 patients ended up with open cholecystectomy [conversion rate of 4.2%]. There were no postoperative complications. Cholesterolosis of the gallbladder is a distinct pathologic entity and carries a positive correlation with high serum cholesterol level. Laparoscopic cholecystectomy is effective, safe and a feasible treatment modality for cholesterolosis

Patología de la vesícula biliar en la provincia de Llanquihue, Chiloé y Palena, X Región de Chile / Gallbladder pathology at Llanquihue, Chiloé and Palena provinces, X region, Chile

Se estudió en forma prospectiva 973 biopsias de vesícula biliar obtenidas entre período abril 1998 a marzo 1999 (81 por ciento sexo femenino, con relación femenino: masculino 4,5). La edad promedio del grupo fue de 46 años. El 67,1 por ciento del material provenía de Puerto Montt y el resto del área insular (Castro y Ancud). La patología inflamatoria presentó la mayor frecuencia con un 96,5 por ciento y la patología neoplásica un 3,4 por ciento. Se encontraron 23 cánceres de la vesícula biliar, de los que sólo uno era incipiente; en un 91,3 por ciento correspondió a sexo femenino, con un promedio de edad de 63 años. De acuerdo a nuestros resultados, la patología vesicular y en particular el cáncer de la vesícula biliar, presentan una alta frecuencia, al igual que en el resto del país, con mortalidades por sobre el promedio nacional y en donde el estudio anatomopatológico protocolizado de la vesícula biliar contribuye de manera significativa al conocimiento de este tipo de patología

Morphological changes in diseased gall bladder: a study of 415 cholecystectomies at Aligarh.

Morphological changes of gall bladder were studied in 415 cholecystectomy specimens. There was a preponderance of females (male to female ratio--1:6.5). The mean age of the cases was 43.6 years. Most of the cases (63.4%) were in the 4th and 5th decades of life. The average duration of illness was 2.8 years. Associated cholelithiasis was present in 85.3% cases. Gall-stones were of mixed variety in 78.2% cases, cholesterol type in 15.3% cases and both types were present in 6.5% cases. Chronic cholecystitis was the main histological diagnosis (50.8%). Other lesions observed were adenomyomatosis (8.2%), adenomatous hyperplasia (10.1%), granulomatous cholecystitis (4.1%), cholesterosis (2.7%), acute cholecystitis (4.1%), acute on chronic infection (10.8%), sub-acute cholecystitis (2.4%) and carcinoma gall bladder (6.8%). The frequency of Rokitansky-Aschoff's sinuses was closely related with the degree of inflammatory response. In 13 (6.2%) cases the diagnosis of chronic follicular cholecystitis was made. All the cases of cholesterosis were multiparous females and of younger age. Of the malignant lesions, adenocarcinoma was the commonest (96.4%).