Gallstone disease

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What is Gallstone disease?

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Gallstone disease is a disease of the Gall Bladder.

Gallstones are solid "stones" which are formed from concretions within the gallbladder. They are two main types - Cholesterol stones (80%), and Pigment stones (20%); Pigment stones are composed of bilirubin - the byproduct of haemoglobin (a component in red blood cells) breakdown.

Who gets Gallstone disease?

Gallstones are present in approxiamately 10-20% of the population.

Gallstones may be present at any age but are unusual before the third decade. There is a progressive increase with age, and in patients over 50 the prevalence ranges between 25-30%. The prevalence is two to three times higher in women than in men.

The third National Health and Nutrition Examination Survey estimated that there are 6.3 million men and 14.2 million women aged 20 to 74 in the United States with gallbladder disease.

Predisposing Factors

Risk factors for cholesterol stones include: high serum cholesterol levels, increased age, female sex, pregnancy, multiparity, obesity, rapid weight loss, the contraceptive pill, hormone replacement therapy, ileal disease and resection, diabetes mellitus, liver cirrhosis, gallbladder stasis, decreased physical activity, Crohn's disease and total parenteral nutrition.

Risk factors for pigment stones include chronic hameolysis (red blood cell breakdown) - hereditary spherocytosis, sickle cell disease, as well as liver cirrhosis. They may also form in the bile ducts after cholecystectomy (surgical removal of the gallbladder).

There are few drugs that promote the formation of gallstones:

Oestrogen - this is present in the hormone replacement therapy and the contraceptive pills

Oral contraceptives

Octreotide - this is used to treat different gastric diseases such as distended veins in the gullet

Clofibrate - this is used to treat high cholesterol in the blood

Ceftriaxone - this is a commonly used antibiotic in the hospital

There are several protective factors against gallstone formation:

Ascorbic acid (this is the active component of Vitamin C)

Coffee

Vegetable protein

Poly- and mono-unsaturated fats (present in vegetable oils)

Progression

Gallstones are asymptomatic in most patients. They are usually an incidental finding on abdominal radiography. Around 2-4% of patients will experience biliary pain during the first 5 years and then this decreases to 1% per year after that. After a first attack, as many as half of these patients will have recurrent episodes within 2 years of their first attack and thus elective surgical removal (cholecystectomy) of the gallbladder is recommended for symptomatic patients.

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