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PubMed1979

[Laparoscopy in chronic gallbladder diseases].

The laparoscopy is the only riskless possibility of directly inspecting the gall-bladder, to ascertain the diagnosis of a chronic cholecystitis, further to consider the indications to internal or surgical measures. For the judgment the form of the gall-bladder, the behaviour of its wall with different colouring, oedema and furthermore its behaviour to neighbouring organs are of decisive evidence. In a disease of the bile-ducts the laparoscopy allows to prove or to exclude a participation of the liver. For the judgment of the activity of a disease of the gall-bladder should, however, always be used clinical and radiological findings, the microbiological investigation of the A-, B-, and C-bile and the testing of the reflex of the gall-bladder. This is necessary with regard to the therapy.

Cholecystitis↗
PubMed1990

Gallbladder disease, bile composition and bile acid absorption after partial ileal bypass.

The incidence of gallbladder disease (gallstones or cholecystectomy) in 24 ileal bypass patients and in 24 unoperated matched controls, all heterozygous for familial hypercholesterolemia, was studied during a follow-up period of nine years on average. Gallbladder disease developed in 6 patients with ileal bypass and in one control patient (p less than 0.05). The operated patients who developed gallbladder disease were slightly older and had a higher serum cholesterol concentration at the start than those who did not, but otherwise the development of gallbladder disease could not be predicted by serum lipids or serial measurement of bile acid and cholesterol synthesis. At the end of the follow-up, the unoperated subjects had gained in weight. Moreover, the biliary lipid composition and the cholesterol saturation index of the bile were similar in the operated (n = 10) and unoperated (n = 10) patients studied. Indirect measurements suggested that the bile acid secretion was not changed by the operation, although the fractional bile acid absorption was significantly lowered in the operated subjects, especially in three subjects taking cholestyramine. All these three subjects had supersaturated bile. It is concluded that ileal bypass carries an increased risk of gallbladder disease although the cholesterol saturation index of the bile shows no significant difference between the operated and the control patients when studied years after the operation, when the control patients have gained in weight.

Adult↗
PubMed2006

Apolipoprotein E genotype and gallbladder disease risk in a large population-based cohort.

PURPOSE: The aim of the study is to describe the association between apolipoprotein E (apoE) genotype and gallbladder disease incidence. METHODS: Cases of incident hospitalized gallbladder disease were ascertained in nearly 13,000 middle-aged men and women participating in the Atherosclerosis Risk in Communities (ARIC) Study, a prospective cohort study in four US communities. RESULTS: Between the ARIC baseline examination (1987 to 1989) and December 31, 2001, a total of 639 participants were hospitalized for gallbladder disease. After adjustment for age, sex, race, obesity, plasma lipid level, and diabetes, the relative risk for hospitalized gallbladder disease associated with the presence of an epsilon4 allele (i.e., genotypes E4/4, E3/4, and E2/4 versus other genotypes) was 0.72 (95% confidence interval [CI], 0.60-0.87). Stratification by race showed that the inverse association with epsilon4 was stronger in whites (relative risk, 0.69; 95% CI, 0.56-0.85) than African Americans (relative risk, 0.86; 95% CI, 0.58-1.30). The presence of the other rare isoform, epsilon2 (i.e., genotypes E2/2, E2/3, and E2/4 versus others) was associated with a modest increased risk for gallbladder disease (relative risk, 1.28; 95% CI, 1.05-1.57). CONCLUSIONS: These results suggest that independent of traditional risk factors, apoE genotype may influence gallbladder disease risk, particularly in whites. The exact biologic mechanism for such an association remains unclear and requires further investigation.

Apolipoproteins E↗
PubMed1996

Should the presence of other diseases exclude subjects as controls in studies of gallbladder response to cholecystokinin octapeptide (sincalide)? Scintigraphic results in patients with malignancies but no known gallbladder disease.

Findings of hepatobiliary scintigraphy with intravenous cholecystokinin octapeptide (sincalide) were examined in 26 asymptomatic patients with various malignancies but no known pre-existing gallbladder disease, and normal hepatobiliary and gallbladder morphology on sonography. The maximum gallbladder ejection fraction (GBEF) following a 30 min infusion of 0.04 of micrograms kg-1 sincalide ranged from 2 to 100%, with a mean of 68%, a median of 78% and GBEF < 35% in five patients (19%), findings similar to those reported in 'normal' subjects. There was no correlation between decreased GBEF and the previous chemotherapy agents received, as well as with gallbladder wall thickness, volume, and whether the gallbladder or small bowel was seen first on scintigraphy. These results suggest that despite the presence of other diseases and histories which include extensive chemotherapy, asymptomatic patients with normal hepatobiliary sonography can serve as controls in studies of gallbladder contractility using sincalide.

Adult↗
PubMedDate not supplied

Drug-induced gallbladder disease. Incidence, aetiology and management.

A great variety of drugs is reported to induce gallbladder disease by various pathogenetic mechanisms. Early epidemiological studies indicated a doubled risk of gallbladder disease in women taking oral contraceptives. More recent studies, however, have failed to confirm those findings; these conflicting results might be explained by the different methods used to define gallbladder disease. It was shown that the lithogenic index of the bile is increased during intake of oral contraceptives. Estrogens cause hypersecretion of cholesterol in bile, due to increase in lipoprotein uptake by the hepatocyte. Progesterone inhibits acyl coenzyme A-cholesterol acyl transferase (ACAT) activity, causing delayed conversion of cholesterol to cholesterol esters. Of the lipid lowering drugs, only clofibrate has been shown to increase the risk for gallstone formation. The other fibric acid derivatives have similar properties, but clinical experience is not as extensive. They seem to be inhibitors of the ACAT enzyme system, thereby rendering bile more lithogenic. Conflicting epidemiological data exist regarding the induction of acute cholecystitis by thiazide diuretics. Ceftriaxone, a third-generation cephalosporin, is reported to induce biliary sludge in 25 to 45% of patients, an effect which is reversible after discontinuing the drug. The sludge is occasionally a clinical problem. It was clearly demonstrated that this sludge is caused by precipitation of the calcium salt of ceftriaxone excreted in the bile. Long term use of octreotide is complicated by gallstone formation in approximately 50% of patients after 1 year of therapy, due to gallbladder stasis. Hepatic artery infusion chemotherapy by implanted pump is shown to be associated with a very high risk of chemically induced cholecystitis. Prophylactic cholecystectomy at the time of pump implantation is therefore advocated. Some drugs, such as erythromcyin or ampicillin, are reported to cause hypersensitivity-induced cholecystitis. Furthermore, there are reports on the influence of cyclosporin, dapsone, anticoagulant treatment, and narcotic and anticholinergic medication in causing gallbladder disease.

Adult↗
PubMed1989

Central adiposity and gallbladder disease in Mexican Americans.

Obesity is widely recognized as a risk factor for gallstones. However, to the authors' knowledge, only one study has examined the effect of body fat distribution on the prevalence of gallbladder disease. Mexican Americans are a population characterized by both a high prevalence of gallbladder disease and an unfavorable body fat distribution. The authors examined whether central adiposity (as measured by the ratio of subscapular-to-triceps skinfold) was related to clinically evident gallbladder disease in 1,202 Mexican Americans and 908 non-Hispanic whites in the San Antonio Heart Study from 1979 to 1982. After adjustment for overall adiposity (as measured by body mass index) and the ratio of subscapular-to-triceps skinfold, an increased prevalence of gallbladder disease was still observed in Mexican-American women. Both body mass index and the ratio of subscapular-to-triceps skinfold were positively and independently associated with gallbladder disease in women, while in men, body mass index, but not the subscapular-to-triceps skinfold ratio, was associated with gallbladder disease. Central adiposity is also related to the adverse pattern of cardiovascular risk factors observed in women with gallbladder disease.

Adult↗
PubMed1984

Gallbladder disease: risk factor for colorectal carcinoma?

The relation between gallbladder disease and the risk of colorectal carcinoma (CRC) is examined in light of 864 consecutive adult postmortem examinations analyzed for significant associations between the state of the gallbladder (normal, cholelithiasis, and cholecystectomy) and the presence of colorectal carcinoma. Our findings supported the known association between female sex and gallbladder disease (p = 0.02) and revealed a significant association between cholelithiasis and/or cholecystectomy and colorectal cancer (p less than 0.02). The frequency of CRC was higher in patients who had a cholecystectomy than in those still with stones, but this difference was not statistically significant. The data suggests a sex-linked dependence between the state of gallbladder and CRC. However, the proper statistical test for this dependence was not significant (p less than 0.25), no doubt as a result of the relatively small amount of data for persons with gallbladder disease. We conclude that the state of gallbladder may modify the risk for colorectal carcinoma.

Cholecystectomy↗
PubMed1998

Ascorbic acid supplement use and the prevalence of gallbladder disease. Heart & Estrogen-Progestin Replacement Study (HERS) Research Group.

To investigate the relation of ascorbic acid supplement use to gallbladder disease and cholecystectomy, we conducted a cross-sectional analysis of baseline from 2744 postmenopausal women, aged 44-79 years, enrolled in the Heart & Estrogen-progestin Replacement Study (HERS), a secondary coronary heart disease prevention trial. A total of 629 HERS participants (23%) reported a history of gallbladder disease. Of these, 508 (19%) also reported a history of cholecystectomy. In bivariate models, ascorbic acid supplement use was associated with a decreased prevalence of gallbladder disease [odds ratio (OR)=0.74; 95% confidence interval (CI), 0.57, 0.96] and a trend toward a decreased prevalence of cholecystectomy (OR=0.77; 95% CI, 0.58, 1.02). Because we detected significant interactions between ascorbic acid supplement use and alcohol consumption, multivariate analyses were performed stratified by drinking status. After adjustment for potential confounding variables, use of ascorbic acid supplements among drinkers was associated with a decreased prevalence of gallbladder disease (adjusted OR=0.50; 95% CI, 0.31, 0.81) and cholecystectomy (adjusted OR=0.38; 95% CI, 0.21, 0.67). Use of ascorbic acid supplements among non-drinkers was not significantly associated with either prevalence of gallbladder disease or cholecystectomy. Further study is necessary to confirm our findings and, specifically, to examine the combined effects of ascorbic acid and alcohol on cholesterol metabolism.

Adult↗
PubMed1993

Clinical gallbladder disease in NIDDM subjects. Relationship to duration of diabetes and severity of glycemia.

OBJECTIVE: To examine the relationship between the prevalence of gallbladder disease and severity of glycemia among diabetic individuals and to provide insight into whether the diabetes-gallstone association is a causal one, because NIDDM patients have an increased prevalence of clinical gallbladder disease. RESEARCH DESIGN AND METHODS: We examined 462 diabetic individuals identified during the San Antonio Heart Study, a population-based survey of diabetes and cardiovascular disease in Mexican Americans and non-Hispanic whites. Diabetes was diagnosed according to National Diabetes Data Group criteria. RESULTS: The prevalence of self-reported gallbladder disease was 34.2% in diabetic women and 7.2% in diabetic men. Although duration of diabetes was positively related to the prevalence of gallbladder disease (P < 0.01), type of therapy was not associated, and fasting glucose concentration was inversely associated with gallbladder disease. CONCLUSIONS: Factors other than hyperglycemia may account for the increased prevalence of gallbladder disease in diabetic subjects.

Adult↗
PubMed1986

A study of a possible association between breast cancer and gallbladder disease.

Because gallstones and breast cancer were reported to have several of the same risk factors, a study was conducted in Washington County, Maryland to determine if women with breast cancer have an increased risk of prior gallbladder disease. Living white female breast cancer cases (n = 133), who were diagnosed from 1973 to 1983, were identified from the county's cancer registry and interviewed along with an equal number of sex-, race-, and age-matched controls about a history of gallbladder disease and other risk factors. Medical records were used to verify a history of gallbladder disease in interviewed cases and controls and to search for a diagnosis of gallbladder disease in 52 white female breast cancer cases who were diagnosed and died between 1974 and 1983, and 52 matched controls. No difference was found in gallbladder disease frequency among living or deceased cases and their matched controls. The results confirm the known association of several risk factors with breast cancer and with gallbladder disease, but most of the risk factors hypothesized to be the same for the two diseases were not the same. However, an unexpectedly strong association was found between gallbladder disease and history of myocardial infarction; this result deserves further study.

Aged↗
PubMed2002

Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease.

BACKGROUND: Morbid obesity is one of the major risk factors for gallbladder disease, and this risk is even greater following rapid weight loss. Because of this, prophylactic cholecystectomy has been offered to our patients undergoing the transected silastic ring vertical Roux-en-Y gastric bypass (TSRVRYGBP). A study was undertaken to determine the incidence of pathologic gallbladders in patients undergoing this prophylactic cholecystectomy. METHOD: The records of all patients who underwent TSRVRYGBP from June 1999 through December 2000 were reviewed. Pathologic findings of the gallbladder were documented as cholelithiasis, cholecystitis, cholesterolosis, polyps or normal. RESULTS: 761 patients underwent the operation. 178 patients (23%) had cholecystectomy before the surgery. 154 (20%) had gallstones documented by ultrasound and had cholecystectomy at the time of the surgery. 324 of the 429 patients with negative preoperative findings by ultrasound had pathologic evidence of gallbladder disease. CONCLUSION: Because of the high incidence of gallbladder disease even with negative preoperative findings in morbidly obese patients and the lack of significant morbidity with cholecystectomy in experienced hands, routine cholecystectomy at the time of the weight loss operation is justified.

Adult↗
PubMed1997

[Occult gallbladder disease or microlithiasis in patients with acute pancreatitis: a frequent clinical event].

BACKGROUND: Patients with acute pancreatitis (AP) and a normal gallbladder by standard echographic evaluation may have "occult" gallbladder disease or microlithiasis with recurrent episodes of AP. AIM: To conduct a prospective evaluation of patients with the diagnosis of non-biliary AP in order to detect "occult" gallbladder disease and to compare its clinical presentation with that of biliary AP. PATIENTS AND METHODS: Patients admitted with the diagnosis of AP to a clinical hospital were included in the study. According to an abdominal ultrasound study, patients were classified as having or not cholelithiasis. A duodenal biliary drainage was performed in 15 patients with AP and without gallbladder stones. RESULTS: Patients without cholelithiasis had recurrent AP more often than patients with biliary AP (53 and 3.3% respectively). Excessive alcohol ingestion did not rule out the possibility of biliary etiology. In 6 patients, the analysis of duodenal bile showed cholesterol crystals, and cholecystectomy confirmed the existence of gallbladder disease in 5. All of them remained asymptomatic during a follow-up period of four years. One patient refused surgery, with subsequent development of gallstones and recurrent episodes of AP. In other 4 patients, gallbladder disease was confirmed by percutaneous gallbladder puncture or during cholecystectomy. No recurrence of AP were observed during the follow-up CONCLUSIONS: Microlithiasis or "occult" gallbladder disease accounts for at least 67% of the original "non-biliary" AP. Duodenal bile analysis is a useful and necessary technique for the evaluation of patients with "non-biliary" acute pancreatitis. Careful clinical and echographic follow-up of this subgroup of patients with AP is mandatory.

Acute Disease↗
PubMed2000

Transpapillary biopsy in gallbladder disease.

BACKGROUND: Endoscopic biopsy is routine in gastrointestinal disease; similarly, histopathologic diagnosis is desirable in gallbladder disease. In this study we examined the clinical usefulness and the problems associated with transpapillary gallbladder biopsy. METHODS: Transpapillary gallbladder biopsy was attempted in 9 patients with gallbladder disease. After inserting a catheter sheath into the gallbladder using a guidewire via the transpapillary route without sphincterotomy, we inserted a biopsy forceps into the lumen of the sheath up to the gallbladder lumen and obtained specimens. RESULTS: We could obtain sufficient specimens for histopathologic diagnosis in 8 of 9 cases (88.9%). Of the 8 successful cases, targeted specimens were obtained in 7 (87.5%). Diagnostic accuracy with respect to malignant versus benign disease was 100% (2 of 2) and 83.3% (5 of 6), respectively. There were no complications. CONCLUSION: Transpapillary gallbladder biopsy is a clinically useful technique because it facilitates histopathologic diagnosis and therefore guides the choice of therapy.

Biopsy↗
PubMed1992

A case-control study of smoking and gallbladder disease: importance of examining time relations.

We report a case-control study of gallbladder disease and cigarette smoking. Subjects were 252 incident cases and 233 age-sex-residence-matched community controls. Three quarters of the subjects were women. The age-matched risk of gallbladder disease was increased in current smokers vs never-smokers [odds ratio (OR) = 1.6 and 1.3 in women and men, respectively] and in past smokers (OR = 1.5 for each sex). In light of earlier research, showing that, in women, certain risk factors for gallbladder disease may act maximally soon after first exposure, we examined time relations. In women, multivariable analysis showed that the risk increase was especially high in current-smoking women less than 35 years of age [OR = 3.5, 95% confidence interval (CI) = 1.2-9.8] and in women who had been smoking for 1-8 years (OR = 2.8, 95% CI = 1.1-7.1). These results indicate that, in women, the smoking-related risk of gallbladder disease is greatest soon after first exposure--as has also been reported for oral contraceptive use. The findings highlight the potential for mis-estimating risk in case-control studies when late-occurring cases have a different relation to the exposure factor than do the early-occurring cases within the original, albeit undocumented, exposure cohort.

Adult↗