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Epidemiology of gallbladder stone disease

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Gallstone disease is common: >700,000 cholecystectomies and costs of ∼$6.5 billion annually in the U.S. The burden of disease is epidemic in American Indians (60–70%); a corresponding decrease occurs in Hispanics of mixed Indian origin. Ten to fifteen per cent of white adults in developed countries harbour gallstones. Frequency is further reduced in Black Americans, East Asia and sub-Saharan Africa. In developed countries, cholesterol gallstones predominate; 15% are black pigment. East Asians develop brown pigment stones in bile ducts, associated with biliary infection or parasites, or in intrahepatic ducts (hepatolithiasis). Certain risk factors for gallstones are immutable: female gender, increasing age and ethnicity/family (genetic traits). Others are modifiable: obesity, the metabolic syndrome, rapid weight loss, certain diseases (cirrhosis, Crohn's disease) and gallbladder stasis (from spinal cord injury or drugs like somatostatin). The only established dietary risk is a high caloric intake. Protective factors include diets containing fibre, vegetable protein, nuts, calcium, vitamin C, coffee and alcohol, plus physical activity.

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The importance of gallstone disease and the impact of ethnicity

Gallstones have been recognized since antiquity, being identified in autopsy studies of Egyptian mummies. Today, gallbladder disease is a frequent problem in developed countries, representing a major health burden.1 An estimated 20–25 million adults in the U.S. are afflicted with gallstones, the most common cause of biliary tract disease in this age group. Gallstone disease is the leading cause of inpatient admissions for gastrointestinal problems.2 Population-based statistics, based on a

Risk factors

Gallstone formation is clearly multifactorial. For any individual, some risk factors are unalterable, such as advancing age, being female and genes/ethnicity. Other factors can be modified, such as obesity, rapid weight loss, diet, drugs and activity. Case-controlled studies (comparing those with versus those without gallstones) have identified associations between key demographic characteristics and the risk of having gallstones. Even when controlled for immutable risk factors (particularly

Summary

The prevalence of gallstone disease has advanced dramatically from the early days of clinical and necropsy studies, with their inherent biases, with the landmark cholecystography survey of Pima Indians in 197013 to the excellent ultrasonographic surveys (accurate, safe and non-invasive) that began predominantly in Europe, especially Italy, in the late 1980s.∗23, 43, 44, 45 Not only did these studies identify the true frequency of cholelithiasis at any point of time (i.e., prevalence), but have

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