A Study of Chemical Composition of Gall Stones in a Tertiary Care Hospital.

ABSTRACT

Gallstones are a major health problem & have been recognized since antiquity. Gallstones are generally classified into pure cholesterol, pigment and mixed type. Knowing the chemical composition of gallstones is essential for determining etiopathogenesis of gallstone disease. Fourier Transform Infrared Spectroscopy (FTIR) method is the most widely used technique in chemical analysis of gall stones. Reports on chemical analysis of gallstones are available from different endemic regions of India. However, no reports are available about the composition and etiopathogenesis of gallstones in Himachal Pradesh. METHODSGallstones from 400 patients of cholelithiasis were collected after cholecystectomy at Indira Gandhi Medical College Hospital (I.G.M.C.), Shimla, between June 2016 to June 2018, and were subjected to chemical analysis by FTIR method. The data was further correlated with regard to age, gender, socio-economic status, various life style factors like diet, obesity, physical activity, with stone number and colour. RESULTSChemical analysis of gall stones revealed that pure cholesterol, mixed and pigment variety were 94 %, 2 % and 4 % respectively. Majority of the patients were below the age of 50 years (66 %). Male to female ratio was 2.71. Both sexes had predominantly pure cholesterol stones. Most of the patients belonged to the lower middle class (56.5 %) & all socio-economic classes showed predominantly pure cholesterol stones. Similarly, there was no predilection of any type of stone to a particular physical work category. 53.5 % patients were non-vegetarians and 46.5 % were vegetarians. There was no correlation between diet and BMI with type of stones. In our study, 66 % of patients had multiple stones. Multiple stones were seen in all varieties of stones. Pure cholesterol stones showed a variety of colours contrary to traditional classification. CONCLUSIONSIn Himalayan population, the predominant type of gall stones were pure cholesterol stones. Mixed stones and pigment containing stones were found in much smaller frequencies. This result is in contrast to that of rest of the Indian subcontinent from where larger percentage of pigment and mixed stones has been reported. And pure cholesterol stones showed maximum variation in colours contrary to our expectation.