IRON & CALCIUM DEFICIENCY – POTENTIAL RISK FACTOR IN THE FORMATION OF BILIARY CALCULI – A PROSPECTIVE STUDY CONDUCTED IN A TERTIARY CARE HOSPITAL OF EASTERN INDIA.

Abstract

Alteration in the serum level of trace elements may be an important causative factor in the formation of biliary calculi. Better understanding of the pathophysiology will help in prevention of this one of the commonest surgical problem in future. Deciency of the trace elements especially iron & calcium interferes with the hepatic enzyme function that precipitates gall stone formation. This hypothesis is supported by few recent studies in animal & human model in India and abroad. This prospective study was planned to evaluate serum concentration of iron & calcium in 2 groups of patients, one group having cholelithiasis and another group undergoing other elective surgical procedures, named cases and controls respectively, over a period of one and half years. It was found that the level of serum iron of the patients with gallstone was signicantly lower than that of the patients without gallstone [p=0.04]. The risk of gallstone formation was also 5.44 times more among the patients with serum iron deciency as compared to the patients with normal level of serum iron and the risk was signicant [OR-5.44(1.61, 48.39);p=0.04]. Moreover, further analysis in the case group shows that the mean level of serum iron for Pigment stone was the highest and that for Cholesterol stone was the lowest and the 2 difference is statistically signicant. Corrected Chi-square (χ ) test showed that there was signicant association between level of serum calcium and patients of the two groups (p=0.026). The risk of gallstone was 7.97 times more among the patients with serum calcium deciency as compared to the patients with normal level of serum calcium and the risk was signicant [OR-7.97(1.04, 67.45);p=0.026]. Also, t-test showed that there was signicant difference in the level of serum calcium of the patients with gallstone than that of the patients without gallstone [t98 = 1.98; p=0.04] . Among the 3 stone groups in the Case arm the mean level of serum calcium for Pigment stone was the highest and that for Cholesterol stone was the lowest, but this difference is not statistically signicant (p=0.08).