Cholelithiasis and biliary sludge in Downs syndrome patients

Boëchat, Márcia Cristina Bastos; Silva, Kátia Silveira da; Llerena Júnior, Juan Clinton; Boëchat, Paulo Roberto Mafra

CONTEXT AND

OBJECTIVE:

Although studies have demonstrated increased frequency of gallbladder abnormalities among Downs syndrome (DS) patients in some countries, there is only one paper on this subject in the Brazilian literature. The aim of this study was to demonstrate the prevalence, clinical characteristics and evolution of lithiasis and biliary sludge among DS patients in a maternity and childrens hospital in Rio de Janeiro. DESIGN AND

SETTING:

This was a cross-sectional study followed by a retrospective cohort study on all individuals with an ultrasound diagnosis of gallbladder abnormalities.

METHODS:

547 DS patients (53.2 percent male, 46.8 percent female) attending the Instituto Fernandes Figueira in 2001 underwent abdominal ultrasound examination at ages of between one day and three years (mean five months). Clinical and ultrasound data were analyzed.

RESULTS:

In 50 patients (9.1 percent), the ultrasound demonstrated gallbladder abnormalities (6.9 percent lithiasis and 2.1 percent biliary sludge). Spontaneous resolution was observed in 66.7 percent of the patients with biliary sludge and 28.9 percent with lithiasis. Cholecystectomy was carried out on 26.3 percent of the patients with gallstones.

CONCLUSION:

The results from this study and comparison with the literature suggest that DS patients are at risk of developing lithiasis and biliary sludge and should be monitored throughout the neonatal period, even if there are no known risk factors for gallstone formation. Most frequently, these gallbladder abnormalities occur without symptoms and spontaneously resolve in most non-symptomatic patients. DS patients should be monitored with serial abdominal ultrasound, and cholecystectomy is indicated for symptomatic cases or when cholecystitis is present.

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