Is there an association between type 1 diabetes in children and Gallbladder stones formation?

A number of studies in adults have evaluated the prevalence of gallstones in the diabetic population and showed a significant association with type 1 diabetes [T1D] and type 2 diabetes. The pediatric literature is limited to a single small case series. We conducted a cross-sectional study to evaluate for the presence of association between T1D in children and gallstones formation. Children diagnosed with T1D in a diabetic clinic have been examined for existence of gall bladder stone formation from November 2008 through November 2009. All have been subjected to the following: History, physical examination, blood tests [liver function tests, lipid profile, glycosylated hemoglobin [HbA1C]], and an ultrasound [US] of the gall bladder. One hundred and five children with T1D have been enrolled consecutively over a 1-year period: age ranged between 8 months and 15.5 years, 62 patients were females. The mean age at diagnosis was 6.3 +/- 2.9 years [range 0.85-11 years], mean duration of T1D was 2.2 +/- 2.1 years [range 0.2-8 years], mean body mass index was 16.5 +/- 3.4, mean HbA1c was 10.7 + - 2.4%, and 61.3% of patients had a HbA1c level >10%. The mean serum cholesterol was 4.16 +/- 0.75 mmol/L [normal 3.65-5.15 mmol/L] and mean serum triglyceride 1.02 +/- 1.3 mmol/L [normal 0-1.7 mmol/L]. Two patients had hyperlipidemia. US of the gallbladder did not show any case of gallstones or sludge formation. Data from our study do not show any association between T1D in children and gallstones formation, with diabetes duration of less than 8 years. The relatively short duration of diabetes and possibility that our study was underpowered might have been reasons for the absence of any association

¿Cuál es la prevalencia de litiasis de la vía biliar principal en pacientes con colecistolitiasis sintomática? / Frequency of choledocholithiasis among patients with cholelithiasis and a clinical suspicion of common bile duct obstruction

INTRODUCCIÓN: La litiasis de la vía biliar principal (LVBP) es la complicación más frecuente de la colecistolitiasis sintomática. Existe controversia acerca de su prevalencia. El objetivo de este estudio es determinar la prevalencia de LVBP en colecistolitiasis sintomática. Material y Método: Estudio de corte transversal. Se estudiaron mediante colangiografía retrógrada endoscópica (CRE), pacientes con colecistolitiasis sintomática y con sospecha de LVBP atendidos en el Hospital Obrero N 1 de la Caja Nacional de Salud La Paz, Bolivia en el período 2005-2006. El tamaño de la muestra se calculó con base en un nivel de confianza de 95%, poder de 80%, frecuencia esperada de LVBP de 59%, y peor escenario de 54%; escenario que da una muestra de 313 pacientes. Se utilizó estadística descriptiva, se calculó prevalencia de LVBP y se aplicó estadística analítica para estudiar asociaciones. Resultados: De los 2001 pacientes internados por colecistolitiasis sintomática, se solicitaron 435 CRE, identificándose en 175 pacientes LVBP, lo que representa una prevalencia de 40,2%. El promedio de edad de los pacientes estudiados fue de 63,1 años y el 51,9% eran de género femenino. Clínicamente, el dolor abdominal, se presentó en 409 pacientes (94,0%), ictericia en 262 casos (60,2%) y alza térmica en 68 pacientes (15,6%). La CRE no identificó lesiones en 68 pacientes (15,6%) y LVBP en 175 casos (40.2%). La morbilidad asociada a la papilotomía endoscópica fue de 4,4%, y no se registró mortalidad. Se verificó asociación entre LVBP y niveles de fosfatasa alcalina (p=0,04), bilirrubina total (p=0,001) y bilirrubina directa (p=0,01). Conclusión: En pacientes portadores de colecistolitiasis sintomática con sospecha de LVBP, la realización de una CRE preoperatoria es una alternativa a considerar.

Background: Choledocholithiasis is the most common complication of symptomatic cholelithiasis. Aim: To evaluate the prevalence of choledocholithiasis among patients with symptomatic cholelithiasis. Patients and Methods: Patients admitted to the hospital with a symptomatic cholelithiasis confirmed by ultrasonography, were subjected to a endoscopic retrograde cholangiography if there was a clinical suspicion of choledocholithiasis. Results: Two thousand and one patients with symptomatic cholelithiasis were admitted and an endoscopic retrograde cholangiography was requested to 435 (age range 14 to 95 years, 226 females). Of these, 409 (94%) had abdominal pain, 263 (60%) had jaundice and 68 (16%) had fever. In 175 (40%) a choledocholithiasis was diagnosed. Sixteen patients (4%) had bleeding after the endoscopic papillotomy, that was self limited in 14, two had an acute pancreatitits and one had a duodenal perforation. There was an association between the presence of choledocholithiasis and serum alkaline phosphatases and bilirubin. Conclusions: Choledocholithiasis is common in patients with cholelithiasis and a clinical suspicion of common bile duct obstruction.