Epidemiology of gallstone disease in Gondar University Hospital, as seen in the department of radiology

Back ground: Gallstone disease is a world wide problem and remains to be one of the most common health problems leading to surgical intervention. The magnitude of Gallstone disease in Ethiopia is not well known. Objective: To assess the magnitude of gallbladder stones in Gondar university hospital among patients visiting at the department of radiology for ultrasound examination. Methods: A retrospective observational study design was used over the period of September 2004 to January 2006 at the department of radiology, Gondar university hospital. Patients above the age of 14 years and whose Gallbladder was examined by ultrasound were considered as the study subjects. Results: Among a total of 1603 study subjects, the proportion of patients with cholelithiasis was 5.2%. Of the patients with gallstone disease 55 were females and 28 were males with a ratio of 2:1. The prevalence of cholelithiasis in the age group 35-64 was 7.3%, 10.1% for females and 4.8 % for males. The ratio of symptomatic to asymptomatic cholelithiasis was 1:1 (34/34). The prevalence of cholelithiasis among patients clinically suspected to have cholelithiasis was 27.2%. Of the 68 patients with cholelithiasis, 22.1% had evidences of complication; 5 (7.4%) choledocholithiasis, 3 (4.4%) acute cholecystitis, 4 (5.9%) chronic cholecystitis, 2 with gallbladder (GB) hydrops and one patient with porcelain GB. Conclusion: The prevalence of cholelithiasis (5.2%) in Gondar university hospital suggesting that cholelithiasis is not an uncommon disease in the area. A further community based and multi centered study is recommended to determine the prevalence of gallstone disease in Ethiopia. [Ethiop.J.Health Dev. 2008;22 (2):206-211] Introduction Gallstone disease (GSD) is a world wide disease and it remains to be one of the most common health problems leading to surgical intervention. Every year about 500,000 cholecystectomies are performed in the United States of America (USA) (1). The prevalence of GSD is about 10% in its adult population. In western Europe the prevalence ranges from 5.9% to 21.9% with the highest prevalence seen in Norway, Sweden, Germany and the lowest in Simion , Italy (2). It has been demonstrated that prevalence of GSD increases with age. In the USA 20% of those 40 years and older and 30% of those above 70 years old have biliary stone with female to male ratio of 4:1. This discrepancy is narrowing in the older population (3). In South America the highest prevalence is found in Chilli with incidence of 1.2/100 women/year (6). The lowest prevalence is found in Asian and African countries (7-15). The reported prevalence in Asia ranges from 4.35-10.7% (7-11). In Africa, the prevalence of GSD was reported from few countries. For instance, in a group of antenatal women, the prevalence was 2.1% in Nigeria, 4% in Tunisia, 5.2% in Sudan and 10% in black women (above 50 years) of Soweto (12-15). There is an increasing incidence of GSD with age, preponderance in females, multiparty, use of oral contraceptive pills and in patients with chronic liver disease, hemolytic disorders and diabetes. Cholelithiasis is rare in pre pubertal children unless associated with a hemolytic disease, congenital anomaly of biliary tree or rare conditions (8, 9,16). The natural history of GSD, according to some studies, indicates 70% remain symptom free (17, 18). GSD can lead to variety of complications including cholecystitis, choledocholithiasis, gallstone ileus, acute gallstone pancreatitis, biliary obstruction, gallbladder empyema or perforation. A study done in Taiwan showed a complication rate of 2% while other studies showed 5872% patients with symptomatic GSD had an ongoing colic or complication (19). Well-documented epidemiological data about the prevalence of cholelithiasis in general and the relative prevalence of asymptomatic and symptomatic cholelithiasis in particular in Ethiopians has been nonexistent. Thus, the main objective of this study is to determine the prevalence of cholelithiasis in Gondar University Hospital (GUH) among patients presenting to the department of radiology for ultrasound examination, and describe the proportion of symptomatic and asymptomatic GSD and look for associated complications. Methods The study is a retrospective study with evaluation of record of patients that came for ultrasound examination at the department of radiology in the period of September 2004 to January 2006. 207 Epidemiology of Gallstone Disease in Gondar University Hospital ______________________________________________________________________________________ Ethiop.J.Health Dev. 2008;22(2) The study area is GUH which is a teaching referral hospital located 720 km North West of Addis Ababa. It is the only referral hospital for North West Ethiopia serving a population of about 5 million. The study subjects were all patients aged 15 years and above who came for ultrasound examination and whose gallbladder was evaluated. Patients with and without symptoms of gallbladder stone were included. During the study period all patients referred for ultrasound had also examination of gallbladder. There were 1746 patients who underwent ultrasound examination of the gall bladder collected from the records of the department. Aloka SSD 500 ultrasound machine with 3.5MHZ frequency curvilinear transducer was used as a definitive diagnostic modality as studies confirmed the specificity and sensitivity of ultrasound being >95% (20). All examinations were done by an experienced radiologist of the university hospital. The data were collected using a structured and pre-tested questionnaire. The variables that were studied include socio-demographic characteristics, clinical presentation, ultrasound finding of GB and Common Bile Duct (CBD), and complication of cholelithiasis. Signs and symptoms of GSD were considered positive if there is a record of right upper quadrant and epigastric pain with or without radiation to shoulder and back, dyspepsia, fat intolerance, and positive Murphy’s sign. Data were collected from the database in the computer and the registry book in the department of radiology. Ethical clearance was obtained from the university research and publication office and got permission from the department. Analysis was done using EPI-INFO version 3.2.2 statistical packages. Results The total number of patients seen in all age groups in the study period was 1746. Excluding those aged 14 years and below, size of the study population was 1603. Of these, 817 were females (51%) and 786 males (49%), with a male to female ratio of 1:1 (Table1). The mean age for females was 37.0 years with SD of 14.3 and for males 42.0 years with SD of 18.2 (Table 1). Of the total study subjects, 920 (58.8%) of patients came from Gondar town and other urban areas while the remaining 644 (41.2%) of patients came from rural areas (Table 1). Table 1. Socio-demographic characteristics of patients and Ultrasound finding of GB, September 2004-January 2006, GUH Age group Normal Gallbladder Gallbladder stone Chole cystectomy Acalculous cholecystitis Gallbladder polyp others total 15-24 309 (97.2%) 7(2.2%) 0 2 (0.6%) 0 0 318 (100%) 25-34 376 (97.2%) 10 (2.6%) 0 1(0.3%) 0 0 387 (100%) 45-54 221(92.1%) 11(4.6%) 4 (1.7%) 0 1(0.4%) 3 (1.3%) 240 (100%) 55-64 150 (91.5%) 10 (6.1%) 4 (2.4%) 0 0 0 164 (100%) 65-74 100 (90.9%) 9 (8.2%) 1(0.9%) 0 0 0 110 (100%) 75-84 48 (96%) 2 (4%) 0 0 0 0 50 (100%) 85-96 7(100%) 0 0 0 0 0 7 (100%) Total 1510 (94.3%) 68 (4.2%) 15 (0.9%) 4 (0.2%) 2 (0.12%) 3 (0.18%) 1602 (100%)