Incidence of Gall Stones in women in
south Libya
Mahmoud H. Milad Amer
Eitwati,* Khalifa M. Alayat,** Muhrez M. Ibrahim,**,**
Abdulqader M. Sufrani,*** Soad M. Hussein,****
Introduction:
Gall stones
(G.S) disease is world wide a major cause of abdominal morbidity leading to hospital
admission in populations.
It is more
common among adults,4 risk factors are multiple and may differ from
one geographic area to another.
For that, many papers are issued studying different risk factors of gall
stones.1-3 It is estimated that 10-20% of the adult populations in
developed countries have gall stones6 , with a higher prevalence in
women.7 Many reports indicate that acute cholecystitis is more
common in diabetic patients.8-9
Method and
Material:
The presence of
gall bladder stones diagnosed by ultrasound in a random group of women, prospectively
studied and analyzed for age, parity, family history, diabetes mellitus,
hypertension, breast feeding and contraceptive pills.
All patients
examined were females above 15years consulting outpatient ultrasound clinic for
gyenobstetric clinic follow up or antenatal care patients presenting with pain
at RHC or those who have had cholecystectomy were also included.
Ultrasound was
performed at radiology department, 2nd March teaching hospital. The
ultrasound device used in the study was ALOKA SDD 4000 color Doppler; the probe
used was 3.5MHz multi-frequency (from 2.5 up to 6MHz).
Diagnosis of
gall stones was done by noticing a stone or the presence of acoustic shadow for
small stones.
Results:
A total of 1130
women have been examined, 167 women were found to have gall stones or previous cholecystectomy
performed for gall stones (14.77%).
Age ranged from
16-70 yrs, with a mean 38yrs. 84 patients have family history of gall stones
(50.2%). Parity range (0-16) births with a mean parity (4.74), 21 women are
either single or nullipara (12.5%).17 women are diabetic (10.17%) and 25 are
hypertensive (14.9%), 134 are breast feeding (80.3%), and only 10 cases gave a
history of contraceptive pill use (5.98%) Table No 1.
Table 1: Comparison between patients and control groups.
|
|
Mean
age |
Family h/o
G.S
|
Mean parity
|
Diabetes
|
Hypertension
|
Breast
Feeding
|
Contraceptive Pill taking
|
|||||
|
|
No
|
%
|
|
No
|
%
|
No
|
%
|
No
|
%
|
No
|
%
|
|
|
Patients
|
38
|
84
|
50.2
|
4.74
|
17
|
10.7
|
25
|
14.9
|
134
|
80.3
|
10
|
5.98%
|
|
Control
|
31.6
|
22
|
13
|
2.4
|
5
|
2.99
|
10
|
5.98
|
73
|
43.7
|
3
|
1.79%
|
33 cases have
pain at RHC or history of pain (19.76%) and 69 cases have had previous
cholecystectomy (41.32) making a total of 102 cases considered as symptomatic
(61%), 65 cases are asymptomatic (39%) Table No. 2.
Table 2: Symptomatic and asymptomatic gall bladder (GB)
patients.
|
GB patients
|
No
|
%
|
|
Symptomatic
|
102
|
61%
|
|
Asymptomatic
|
65
|
39%
|
|
Total
|
167
|
100%
|
*)
Department of radiology, 2nd March teaching hospital, Sebha, Libya.
**) Department
of surgery, 2nd March teaching hospital, Sebha, Libya.
***) Department
of medicine, 2nd March teaching hospital, Sebha, Libya.
****) Department
of gyn-obs, 2nd March teaching hospital, Sebha, Libya.
Out of the
963examined women without gall stones, 167 cases were randomly selected as a
control group compared with 167 cases with gall stones for the risk factors in
question. Table No. 1 compares GB stones with a control group for different
risk factors.
Table No 3.
|
Age group
|
No. of cases
|
|
15-24
|
15
|
|
25-34
|
63
|
|
35-44
|
48
|
|
45-54
|
23
|
|
55-64
|
12
|
|
≥65
|
3
|
Discussion:-
In our study,
the maximum incidence of gall stones was in the age group (25-34yrs), 63
patients (37.7%) while Kratzer et al1 showed highest incidence in
the age group (51-65) (13.7%). Borch et al2 in a Swedish study of
gall stones prevalence showed a maximum incidence at older age groups >75
yrs (53%) had gall stones.
84 patients
(50.2%) have had family history of gall stones compared to (11.5%) by Kratzer
et al.1
87.5% of women
with gall stones have child birth with a mean parity 4.7, while 12.5% are
nullipara.
Pannwitz et al3
in a German study showed 23% of multipara women had gall stones and only 3.1% of
nullipara had gall stones.
The overall
incidence of G.S disease in women is 14.77% in our study, while Kratzer et al1
in a German study found that 33.8% of women had G.S.
In our study,
only 10 patients of G.S had a history of contraceptive pills taking (5.98%),
while Pannwitz et al3 in a German study showed that the incidence of
GS in patients taking contraceptive pills icreases with age 5.9% in 24yrs, 20%
in 25-44yrs age group and 30% in 45-54yrs age group.
10.17% of GS
patients are diabetic while Torben5 in a Danish study found 23.8% of
diabetics have sail stones.
Table No 4: Comparison of results
|
|
Khalifa & Mahmoud
|
Kratzer
|
Pannwitz
|
Torben
|
Borch
|
|
Mean age
|
37.7
|
33.8
|
&&&&&
|
&&&&&
|
&&&&&
|
|
Incidence of GS
|
14.77
|
13.7
|
&&&&&
|
&&&&&
|
&&&&&
|
|
Family history
|
50.2
|
11.5
|
&&&&&
|
&&&&&
|
&&&&&
|
|
Contraceptive
|
5.98
|
&&&&&
|
30%
|
&&&&&
|
&&&&&
|
|
D.M
|
10.17
|
&&&&&
|
&&&&&
|
23.8
|
&&&&&
|
|
Parity
|
&&&&&
|
&&&&&
|
&&&&&
|
&&&&&
|
&&&&&
|
|
Maximum age
incidence
|
25-35yrs
|
51-65yrs
|
&&&&&
|
&&&&&
|
≥75
|
References:
1. Krazter W, Kachele V, et al. Gall stone prevalence in
Germany. Volume 43;6. 1998, 1285-1291.
2. Borch k, Janson K.A, et al. Prevalence of gall stone
disease in a Swedish population .Scandinavian journal of gastroenterology. 1998;
23(11):1219-1225.
3. Pannwitz H, Berndt H, and Nurnberg D. Prevalence of
cholelithiasis in relation to use of hormonal contraceptive. Gastroen-terology
journal. 1990; 50(2): 78-81.
4. Beckingham LJ. ABC of gall stone disease. BMJ, 2001;
322:91-94.
5. Torben Jorgensen. Gall stone in a Danish population. G U
T, 1989; Vol. 30(4):528-534.
6. Rome group for the epidemiology and prevention of
cholelithiasis (GREPCO). Prevalence of gall stone in adult female population. Amj
epidemiology, 1984; 119: 796-805.
7. Bateson Me, Bouchier IAD. Prevalence of gall bladder
disease in Dundee a necropsy study. Br Med J, 1975:4:427-430.
8. Sandler RS, Maule WF, Baltus ME. Factors associated with
postoperative complication in diabetics after biliary tract surgery.
9. Ransohff DF, Miller Gl, Hermann RE. Outcome of acute
cholecystitis in patients with diabetes mellitus. Ann Intern Med, 1987;
106:829-32
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