Asymptomatic Gallstones Research Articles

Predictors of improvement in health-related quality of life in patients undergoing cholecystectomy.

Few studies have assessed health-related quality of life (HRQoL) among patients undergoing cholecystectomy. This study aimed to determine clinical variables that predict changes in HRQoL following cholecystectomy. This was a prospective study of consecutive patients undergoing elective cholecystectomy for gallstones in six hospitals. Patients were asked to complete two questionnaires-the Short Form 36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI)-before and 3 months after cholecystectomy. Multivariate linear regression models were used to examine factors potentially contributing to changes in HRQoL. Patients with symptomatic cholelithiasis and low surgical risk experienced the highest HRQoL gains in several SF-36 and GIQLI domains, with significant improvements in physical function detected by both instruments, compared with asymptomatic individuals at high surgical risk. Patients with asymptomatic cholelithiasis or high surgical risk experienced least improvement. These data indicate that cholecystectomy is appropriate for patients with symptomatic cholelithiasis and low surgical risk. In terms of HRQoL, the risk to benefit ratio seems poor for patients with asymptomatic gallstones.

The burden of gallstone disease in Europe.

Gallstones are common and may be associated with recurrent bouts of upper abdominal pain, often with nausea and ⁄ or vomiting. The frequency of gallstones increases with age, female gender and obesity. The majority of gallstones are asymptomatic. Despite this, gallstone disease is the most common abdominal condition for which patients are admitted to hospital in developed countries. Medical presentations usually result from complications or through routine investigations for abdominal pain. Complications attributable to gallstones include chronic inflammation ⁄ infection of the gallbladder (cholecystitis), abscess formation, and biliary obstruction, which can result in jaundice or a severe ascending infection of the bile ducts and acute pancreatitis. Most uncomplicated cases that present to clinicians can be effectively treated by keyhole surgery (laparoscopic cholecystectomy), but patients with more severe disease often require multidisciplinary management, involving radiological, gastroenterological and surgical services. Medical management other than the use of antibiotics to treat infection are infrequently employed due to the poor long-term response rates. Although now uncommon, severe cases can be associated with significant morbidity and mortality, particularly in frail or elderly patients. To determine the recent prevalence and incidence rates of gallstones, their complications and surgical treatments in Europe, a MedLine database search from 1989 to 2003 was performed.

Impact of laparoscopy on frequency of surgery for treatment of gallstones.

Although the indications for laparoscopic cholecystectomy are generally the same as those for open cholecystectomy, there has been a suspicion that indications for cholecystectomy have broadened and the spectrum of patients undergoing this procedure has changed. This study was designed to determine whether surgeons and patients have lowered the threshold for proceeding to cholecystectomy with use of laparoscopic cholecystectomy. Discharge data were collected for all patients who underwent an elective operation in general surgery clinics in Ankara Numune Teaching and Research Hospital between 1990 to 2001. The rate of total cholecystectomy to all elective operations and rate of laparoscopic technique to all cholecystectomies were analyzed. Total number of operations and rate of cholecystectomy were relatively stable over 6 years prior to laparoscopy. With the introduction of laparoscopic cholecystectomy, although total number of elective operations seems stable, the proportion of cholecystectomy to all operations showed an increase. Our study could not explain the increase of total number of cholecystectomies since the widespread introduction of laparoscopy. First, it may be due to changing selection criteria for surgical treatment of gallstones. Second, surgery may have been done for asymptomatic gallstones. And third, patients with moderate symptoms who refused the (open) operation in the past may now be more willing to undergo a laparoscopic cholecystectomy.

Should cholecystectomy be performed for asymptomatic cholelithiasis in transplant patients?

In the general population, the standard of treatment for asymptomatic gallstones is expectant management. The management of asymptomatic gallstones in solid organ transplant recipients has been controversial based on reports in the literature of an increased prevalence of gallstones and increased risk of complications from posttransplantation cholecystitis. Previous recommendations have been based on limited case series and have encompassed the full range of options, including expectant management, routine screening with pretransplantation cholecystectomy, and prophylactic cholecystectomy posttransplantation. These different management strategies have not been systematically evaluated. Patients undergoing solid organ transplantation exhibit several unique components of biliary disease. Differences in the prevalence of gallstones, their natural history, and the morbidity and mortality of preand posttransplantation cholecystectomy must be considered in developing a management plan for asymptomatic cholelithiasis in transplantation patients compared with the general population. This article summarizes previously published reports that have attempted to answer the question: Is prophylactic cholecystectomy indicated in adult solid organ (heart, lung, kidney, and pancreas) transplant recipients? While bone marrow transplantation patients also demonstrate similar tendencies toward the development of cholelithiasis and biliary sludge, this article is limited to adult solid organ transplantation recipients. Liver transplantation patients are reported to have an increased incidence of sludge and gallstones also, but undergo cholecystectomy at the time of hepatectomy, and so are excluded from this analysis. PATHOPHYSIOLOGY While the development of gallstones probably results from an interaction between environmental and genetic factors, alterations in physiologic states associated with organ transplantation might also impact the development of gallstones.

Risk factors for symptomatic gallstones in patients with liver cirrhosis: a case-control study.

Liver cirrhosis is a well-documented risk factor for the formation of gallstones. In cirrhotic patients, gallstones are almost always "silent," and surgery is rarely required. When indicated (symptoms or complications), cholecystectomy implies a high morbidity risk in these patients, especially in the advanced stages of cirrhosis. The aim of this study was to estimate the risk factors for symptom development in cirrhotic patients with gallstones to identify the subgroup of patients at risk of undergoing surgery. A total of 140 patients with liver cirrhosis and gallstones were studied: 97 with asymptomatic and 43 with symptomatic gallstone disease. The risk factors for gallstone formation (age, gender, family history, parity, obesity, diabetes mellitus, hyperlipoproteinemia) and the characteristics of liver cirrhosis (etiology, duration, Child class, hypersplenism), gallstones (duration, number, size), and gallbladder (size, wall thickness) were assessed in all patients. In 12 patients (four symptomatic, eight asymptomatic), gallbladder emptying was also evaluated by ultrasound. The association of asymptomatic and symptomatic gallstones with all these parameters was statistically evaluated by Student's t, Mann-Whitney, and chi(2) tests, as well as by means of multiple logistic regression. The causal relationship between these characteristics and gallstone symptoms was also examined by means of the KDD (knowledge discovery from databases) method, with an algorithm for learning Bayesian networks. Advanced age, female gender, viral etiology of cirrhosis, family history of gallstones, and duration of gallstone disease were significantly associated with symptomatic gallstone disease. The number or size of gallstones and the size or emptying of the gallbladder did not differ in symptomatic versus asymptomatic patients. Male gender and alcoholic cirrhosis were inversely correlated with symptom presence. In the multivariate analysis, family history (p = 0.0098) and advanced age (p = 0.0422) were positively correlated and male gender (p = 0.0049) and alcoholic etiology of cirrhosis (p = 0.0116) negatively correlated with symptom presence. These relationships (except for age) were also evidenced by the KDD method. The risk of gallstones becoming symptomatic is significantly lower in men and in alcoholic cirrhosis. In cirrhotic women, and especially in the presence of a positive family history and of advanced age, the risk of developing symptoms and undergoing surgery was significantly greater.

Risk factors for symptomatic gallstones in patients with liver cirrhosis: a case–control study

Objective Liver cirrhosis is a well-documented risk factor for the formation of gallstones. In cirrhotic patients, gallstones are almost always “silent,” and surgery is rarely required. When indicated (symptoms or complications), cholecystectomy implies a high morbidity risk in these patients, especially in the advanced stages of cirrhosis. The aim of this study was to estimate the risk factors for symptom development in cirrhotic patients with gallstones to identify the subgroup of patients at risk of undergoing surgery. Methods A total of 140 patients with liver cirrhosis and gallstones were studied: 97 with asymptomatic and 43 with symptomatic gallstone disease. The risk factors for gallstone formation (age, gender, family history, parity, obesity, diabetes mellitus, hyperlipoproteinemia) and the characteristics of liver cirrhosis (etiology, duration, Child class, hypersplenism), gallstones (duration, number, size), and gallbladder (size, wall thickness) were assessed in all patients. In 12 patients (four symptomatic, eight asymptomatic), gallbladder emptying was also evaluated by ultrasound. The association of asymptomatic and symptomatic gallstones with all these parameters was statistically evaluated by Student’s t, Mann-Whitney, and χ 2 tests, as well as by means of multiple logistic regression. The causal relationship between these characteristics and gallstone symptoms was also examined by means of the KDD (knowledge discovery from databases) method, with an algorithm for learning Bayesian networks. Results Advanced age, female gender, viral etiology of cirrhosis, family history of gallstones, and duration of gallstone disease were significantly associated with symptomatic gallstone disease. The number or size of gallstones and the size or emptying of the gallbladder did not differ in symptomatic versus asymptomatic patients. Male gender and alcoholic cirrhosis were inversely correlated with symptom presence. In the multivariate analysis, family history ( p = 0.0098) and advanced age ( p = 0.0422) were positively correlated and male gender ( p = 0.0049) and alcoholic etiology of cirrhosis ( p = 0.0116) negatively correlated with symptom presence. These relationships (except for age) were also evidenced by the KDD method. Conclusions The risk of gallstones becoming symptomatic is significantly lower in men and in alcoholic cirrhosis. In cirrhotic women, and especially in the presence of a positive family history and of advanced age, the risk of developing symptoms and undergoing surgery was significantly greater.

Common presence of Helicobacter DNA in the gallbladder of patients with gallstone diseases and controls.

Several species of Helicobacter colonise the biliary tract of animals and cause hepatobiliary diseases. Helicobacter species have also been identified in the gallbladder of a high proportion of Chilean patients with gallbladder cancer. To determine the presence of Helicobacter species, particularly Helicobacter pylori and Helicobacter bilis, in the gallbladder of patients with non-malignant gallbladder diseases and control patients. DNA was extracted from gallbladder samples from 122 consecutive patients undergoing cholecystectomy. The presence of Helicobacter genus-specific or Helicobacter pylori and Helicobacter bilis species-specific DNA was determined by polymerase chain reaction and sequence analysis. The presence of Helicobacter pylori-specific immunoglobulin G in the serum (n=84) and bile (n=104) samples was determined by enzyme linked immunosorbent assay. Helicobacter DNA was detected in 61 (50.0%) gallbladder samples: 29 of 60 (48.3%) patients with symptomatic gallstone, six of 10 (60.0%) patients with asymptomatic gallstones, 11 of 15 (73.3%) patients with other biliary diseases, and 15 of 37 (40.5%) control patients, respectively. Among them, 39 samples were positive for Helicobacter pylori but none were positive for Helicobacter bilis. Sequence analysis of Helicobacter genus-positive samples showed that 56 samples were Helicobacter pylori and five were Helicobacter species 'Liver 3' strain. Overall, there was no significant difference in the detection rate of Helicobacter DNA or the levels of serum and bile Helicobacter pylori-specific immunoglobulin G in the various biliary disease groups compared with control patients. Neither was there any significant difference in the blood biochemistry and liver function tests between patients with positive and negative Helicobacter DNA detection. Helicobacter species' DNA are commonly present in the gallbladder of patients with gallstone diseases and in controls, implying that Helicobacter infection alone may not play a significant role in the formation of gallstones. However, our results do not exclude the possibility of Helicobacter infection as a cofactor in the development of gallstones.

Biliary Lithiasis: Prevalence and Ultrasound Profile in a Service Hospital.

Real time gray scale ultrasonography of upper abdomen was carried out in 1237 cases for varied indications. Overall prevalence of biliary lithiasis was 11.56% with female to male ratio of 4:1. Fifty years and below, female to male ratio was 6.5:1. 88.8% cases of biliary lithiasis were 60 years and below. Gall bladder dyspepsia (61.5%) and right upper quadrant pain (41%) were the main presenting features of biliary lithiasis. 26 patients (18%) presented with acute abdomen. Asymptomatic gallstones were found in 25 (17.5%) cases. Solitary calculus was less common than multiple calculi with a ratio of 1:4. Amongst cases of multiple calculi the small sized (2-4 mm) variety was the maximum (49%) followed by medium sized (5-10mm) and large sized (>10mm) calculi respectively.

Cholelithiasis in infant and pediatric heart transplant patients.

There have been numerous studies which demonstrate a relatively high incidence of gallstones in adult solid-organ transplant recipients receiving cyclosporin A (CsA) immunosuppression. The purpose of the present study was to investigate our experience with cholelithiasis in babies and children undergoing heart transplant (HTx). From May 1985 to December 1998, 311 neonatal and pediatric cardiac transplants were performed at our institution. Routine abdominal ultrasound was performed at 3 months, 1 yr, and bi-annually thereafter on all transplant recipients. Asymptomatic or symptomatic gallstone development was detected during abdominal ultrasound in 10 of 311 patients (3.2%). Eight of these 10 patients (80%) were transplanted when younger than 3 months of age. Eight per cent of all infants transplanted at < 3 months of age developed cholelithiasis (p < 0.05 compared to older age at HTx). Fifty per cent of gallstones were detected and treated within 6 months post-HTx, while the remaining 50% of patients with gallstones underwent cholecystectomy 3-6 yr later. Only 20% (two of 10) had symptoms of cholelithiasis/cholecystitis. Five patients (50%) underwent laparoscopic cholecystectomy. Only one patient older than 1 yr of age, who was symptomatic, underwent open cholecystectomy. There were no complications from surgery. There were no differences in liver function tests or cholesterol levels in transplant recipients with or without gallstones, and all mean values were within normal limits. Hence, although the incidence of pediatric post-transplant cholelithiasis in infant and pediatric heart transplant recipients is low, almost all occurrences are associated with HTx during early infancy and, because of this, patients in this group should be routinely screened. Laparoscopic or open cholecystectomy are extremely well tolerated and we recommend that surgery be performed when cholelithiasis is found in pediatric heart treatment patients.

Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus.

Gallstone is a common disease with a 10% prevalence in the United States and Western Europe. However, it is only symptomatic in 20-30% of patients, with biliary pain "colic" being the most common symptom. Complications of asymptomatic gallstone disease are generally rare, with an incidence of <1 %/yr. The most common complications of gallstone disease are acute cholecystitis, acute pancreatitis, ascending cholangitis, and gangrenous gallbladder. Less frequent complications include Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Mirizzi syndrome and cholecystocholedochal fistula are two manifestations of the same process that starts with impaction of a gallstone in the gallbladder neck that results in obstruction of the bile duct, causing jaundice. The gallstone may erode into the bile duct, causing cholecystocholedochal fistula. Gallstone ileus refers to small bowel obstruction resulting from the impaction of one or more gallstones after they have migrated through a cholecystoenteric fistula. An accurate diagnosis is essential to the management and prevention of further complications. A variety of imaging and endoscopic modalities are used to make the diagnosis once the condition is suspected clinically. Treatment should be tailored to each individual patient. Management choices include ERCP, lithotripsy (endoscopic or extracorporeal), and surgery. Prognosis is frequently related to early recognition, management of any comorbid conditions, and careful selection of treatment modalities.

Epidemiology and molecular pathology of gallbladder cancer.

Gallbladder cancer is usually associated with gallstone disease, late diagnosis, unsatisfactory treatment, and poor prognosis. We report here the worldwide geographical distribution of gallbladder cancer, review the main etiologic hypotheses, and provide some comments on perspectives for prevention. The highest incidence rate of gallbladder cancer is found among populations of the Andean area, North American Indians, and Mexican Americans. Gallbladder cancer is up to three times higher among women than men in all populations. The highest incidence rates in Europe are found in Poland, the Czech Republic, and Slovakia. Incidence rates in other regions of the world are relatively low. The highest mortality rates are also reported from South America, 3.5-15.5 per 100,000 among Chilean Mapuche Indians, Bolivians, and Chilean Hispanics. Intermediate rates, 3.7 to 9.1 per 100,000, are reported from Peru, Ecuador, Colombia, and Brazil. Mortality rates are low in North America, with the exception of high rates among American Indians in New Mexico (11.3 per 100,000) and among Mexican Americans. The main associated risk factors identified so far include cholelithiasis (especially untreated chronic symptomatic gallstones), obesity, reproductive factors, chronic infections of the gallbladder, and environmental exposure to specific chemicals. These suspected factors likely represent promoters of carcinogenesis. The main limitations of epidemiologic studies on gallbladder cancer are the small sample sizes and specific problems in quantifying exposure to putative risk factors. The natural history of gallbladder disease should be characterized to support the allocation of more resources for early treatment of symptomatic gallbladder disease in high-risk populations. Secondary prevention of gallbladder cancer could be effective if supported by cost-effective studies of prophylactic cholecystectomy among asymptomatic gallstone patients in high-risk areas.

The effect of cholestyramlne on gallbladder motillity and liver biochemistry in patients with primary sclerosing cholangitis (PSC)

Background: The prevalence of cholesterol gallstones has substantially increased in the last century, especially in affluent countries. Genetic and environmental factors have been implicated in the pathogenesis of gallstones. Yet, the role of many specific environmental factors remains unclear or controversial. Aim: To study the role of diet and lifestyle habits in asymptomatic gallstone disease. Methods: Subjects with asymptomatic, gallbladder stones detected by ultrasonography (US) were enrolled. A total of 103 newly diagnosed patients (75 females, 28 males) were matched by age, sex and ethnic origin to 103 gallstone-free subjects. All subjects underwent abdominal US and were extensively interviewed on their dietary habits using a Food Frequency Questionnaire, and on their lifestyle habits. Major food items were analyzed for their phospholipid content and included in the food composition tables. Results: The paired analysis revealed the following dietary risk factors for the development of gallstones: Total fat intake (p = 0.038), especially fat of animal origin (p = 0.001), total protein (p<O.OOl), protein of animal origin (p<O,OOl), chicken (p<O.O01) and phosphatidylsedne (p=0.016). The following factors were found to be protective: Dietary fiber (p = 0.009), starch (p = 0.03), zinc (p = 0.028) and alcohol (p = 0.039). In addition, high BMI (p<O.O01), serum cholesterol (p=O.042) and triglyceddes (p=O.OO8), marital status (p=O.OOf) and a family history of gallstones (p<O.O05) were found to correlate with the presence of gallstones. Conclusions: The results of the study indicate that nutritional factors are strongly associated with gallstone disease, as risk factors as well as protective factors. The significant association with fat and protein of animal origin, suggests that foods, of this origin should be avoided by subjects with any additional risk of gallstone development.

The emerging understanding of sickle cell disease.

The emerging understanding of sickle cell disease.

The Effect of Acute Oral Erythromycin on Gallbladder Motility and on Upper Gastrointestinal Symptoms in Gastrectomized Patients With and Without Gallstones: A Randomized, Placebo-Controlled Ultrasonographic Study

Gastrectomy might be a risk factor for cholelithiasis and gallbladder stasis might play a major role. We studied fasting and postprandial gallbladder motility with 600 mg oral erythromycin or placebo in gastrectomized patients (with and without gallstones) and controls. Seventeen patients operated on for gastric cancer (subtotal gastrectomy: n = 10, total gastrectomy: n = 7) were compared with 20 sex- and body-size matched healthy controls. Subjects randomly received erythromycin or placebo 30 min before the ingestion of a standard 200 ml liquid test meal. Gallbladder volume was estimated by ultrasonography until 120 min after test meal. A visual analog scale monitored GI perception of appetite, satiety, nausea, abdominal fullness and epigastric pain. Gastrectomized patients had increased fasting gallbladder volume (35.9 +/- 3.4 ml versus 21.0 +/- 1.4 ml, p = 0.0005) with faster postmeal emptying (T/2 14.8 +/- 1.1 min versus 23.5 +/- 1.5 min, p = 0.00019) than controls. Six patients developed small and asymptomatic gallstones, which did not influence gallbladder motility. In these patients, fasting gallbladder volume increased with time after surgery (r = +0.82, p = 0.047). Perception of satiety, abdominal fullness, and epigastric pain after ingestion of the test meal were all significantly greater in patients than in controls. Erythromycin significantly enhanced gallbladder emptying during fasting (p = 0.001) and postprandially in both patients and controls (0.002 < p < 0.017) and significantly reduced postmeal satiety and epigastric discomfort in gastrectomized patients. Increased fasting volume might be a form of stasis, predisposing patients to gallstone formation. Erythromycin improves fasting and postprandial gallbladder emptying and decreases upper GI symptoms in gastrectomized patients.

The effect of acute oral erythromycin on gallbladder motility and on upper gastrointestinal symptoms in gastrectomized patients with and without gallstones: a randomized, placebo-controlled ultrasonographic study

OBJECTIVE: Gastrectomy might be a risk factor for cholelithiasis and gallbladder stasis might play a major role. We studied fasting and postprandial gallbladder motility with 600 mg oral erythromycin or placebo in gastrectomized patients (with and without gallstones) and controls. METHODS: Seventeen patients operated on for gastric cancer (subtotal gastrectomy: n = 10, total gastrectomy: n = 7) were compared with 20 sex- and body-size matched healthy controls. Subjects randomly received erythromycin or placebo 30 min before the ingestion of a standard 200 ml liquid test meal. Gallbladder volume was estimated by ultrasonography until 120 min after test meal. A visual analog scale monitored GI perception of appetite, satiety, nausea, abdominal fullness and epigastric pain. RESULTS: Gastrectomized patients had increased fasting gallbladder volume (35.9 ± 3.4 ml versus 21.0 ± 1.4 ml, p = 0.0005) with faster postmeal emptying (T/2 14.8 ± 1.1 min versus 23.5 ± 1.5 min, p = 0.00019) than controls. Six patients developed small and asymptomatic gallstones, which did not influence gallbladder motility. In these patients, fasting gallbladder volume increased with time after surgery (r = +0.82, p = 0.047). Perception of satiety, abdominal fullness, and epigastric pain after ingestion of the test meal were all significantly greater in patients than in controls. Erythromycin significantly enhanced gallbladder emptying during fasting ( p = 0.001) and postprandially in both patients and controls (0.002< p < 0.017) and significantly reduced postmeal satiety and epigastric discomfort in gastrectomized patients. CONCLUSIONS: Increased fasting volume might be a form of stasis, predisposing patients to gallstone formation. Erythromycin improves fasting and postprandial gallbladder emptying and decreases upper GI symptoms in gastrectomized patients.

Tecnetium-99m iminodiacetic acid (HIDA) scintigraphy in the diagnosis of biochemical cholestasis: A clinical study in a non jaundiced asymptomatic gallstone population with concomitant liver desease and normal US and CT

Tecnetium-99m iminodiacetic acid (HIDA) scintigraphy in the diagnosis of biochemical cholestasis: A clinical study in a non jaundiced asymptomatic gallstone population with concomitant liver desease and normal US and CT

Number and size of stones in patients with asymptomatic and symptomatic gallstones and gallbladder carcinoma: A prospective study of 592 cases

The development of gallbladder carcinoma has been correlated with the presence of a single large gallstone in two retrospective studies. The objective of the present study was to determine the number and size of gallstones in patients with gallbladder carcinoma compared to asymptomatic and symptomatic female patients with gallstones. The following three groups of patients were included in this prospective trial: (A) 78 asymptomatic patients with gallstones; (B) 365 symptomatic patients with gallstones; and (C) 149 patients with gallbladder carcinoma. At the end of the operation, the resected gallbladder was opened and the number of stones counted. The maximum size of the stones was determined using calipers. Patients with gallbladder carcinoma were significantly older than patients in the other two groups ( P <0.001). In the group with asymptomatic gallstones, there were significantly more patients with one single stone, whereas in the group with gallbladder carcinoma there were significantly more patients with multiple stones (more than 11; P <0.01). Patients with gallbladder carcinoma had significantly larger stones, regardless of the number of stones present ( P <0.001). We postulate that the increase in the number and size of the stones among patients with gallbladder carcinoma could simply be an effect of aging or it could be a reflection of the long-term presence of stones in the gallbladder rather than some particular chemical or physical influence.

Atypical gastrointestinal symptoms are not associated with gallstones in patients with spinal cord injury

Moonka R, Stiens SA, Stelzner M. Atypical gastrointestinal symptoms are not associated with gallstones in patients with spinal cord injury. Arch Phys Med Rehabil 2000;81:1085-9. Objective: To determine if nonspecific gastrointestinal (GI) symptoms justify cholecystectomy in patients with spinal cord injury (SCI). Design: The frequency of GI symptoms was determined in a sample of patients with SCI in whom the presence or absence of gallstones had been previously determined by screening ultrasonography or a known history of cholecystectomy. The prevalence of various symptoms in patients with and without gallstones was compared. Setting: The Spinal Cord Injury Unit of the Veterans Affairs Puget Sound Health Care System, which provides rehabilitation and longitudinal primary care for SCI veterans. Patients: Two hundred ninety-four patients who had undergone either right upper quadrant ultrasonography or cholecystectomy in the past, and who completed a questionnaire concerning GI symptoms. Main Outcome Measure: Bivariate logistic regression was used to calculate odds ratios (ORs) to determine the strength of associations between the presence of each symptom and the presence of gallstones. Results: Pain in the right upper quadrant or epigastrium that occurred after meals or at night was significantly associated with gallstones (OR: 3.5; 95% confidence interval [CI] 1.02-11.73). Abdominal pain in other locations and nonspecific symptoms such as bloating and nausea, were not predictive of the presence of gallstones. Conclusions: Nonspecific symptoms in patients with SCI are not associated with gallstones and do not justify cholecystectomy in patients with otherwise asymptomatic gallstones. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Serum ascorbic acid and gallbladder disease prevalence among US adults: the Third National Health and Nutrition Examination Survey (NHANES III).

Ascorbic acid-deficient guinea pigs frequently develop gallstones, and ascorbic acid status may also affect the risk of gallbladder disease in humans. To examine the relationship of ascorbic acid, an antioxidant nutrient involved in cholesterol catabolism, to gallbladder disease, we analyzed data collected from a probability sample of US adults. Analyses of data from 7042 women and 6088 men enrolled in the Third National Health and Nutrition Examination Survey, 1988-1994, were performed. Multiple logistic regression models stratified by sex were examined, controlling for the effects of age, race, diet, body mass index, and other potential confounders. A total of 761 women (11%) and 235 men (4%) reported a history of clinical gallbladder disease (symptomatic gallstones or cholecystectomy). Of the 9650 participants without a history of clinical gallbladder disease or abdominal pain consistent with gallbladder disease, and with valid abdominal ultrasonography, 408 (8%) of 4863 women and 274 (6%) of 4787 men had asymptomatic gallstones. Serum ascorbic acid level was inversely related to prevalence of clinical and asymptomatic gallbladder disease among women, but not among men. Among women, each SD (27 micromol/L) increase in serum ascorbic acid level was independently associated with a 13% lower prevalence of clinical gallbladder disease (P = .006) and asymptomatic gallstones (P = .048). Ascorbic acid, which affects the catabolism of cholesterol to bile acids and, in turn, the development of gallbladder disease in experimental animals, may affect the risk of gallbladder disease among women.

Laparoscopic Cholecystectomy to Treat Patients with Asymptomatic Gallstones

Background/Aims: The management of patients with silent or asymptomatic gallstones remains controversial. The objective of this study is to determine the complications of laparoscopic cholecystectomy performed to treat patients under 50 years of age with asymptomatic gallstones. Method: 207 patients, 13–49 years of age with asymptomatic gallstones, were subjected to laparoscopic cholecystectomy. There were 161 (78%) women and 46 (22%) men. Results: Operative time varied from 25 to 95 min, with an average of 42 min. The length of hospitalization varied from 12 h to 2 days. In no patient was the operation converted to laparotomy. There was neither mortality nor major complications. The following minor complications were observed: vomiting in 43 patients (20.7%), fever in 16 (7.7%), minor skin infection in 7 (3.3%), and keloid in 2 (0.9%). Conclusion: It is concluded from this study that laparoscopic cholecystectomy is a safe procedure in the treatment of patients under 50 years of age with asymptomatic gallstones.