Epidemiology of gallbladder disease: cholelithiasis and cancer

Abstract

Diseases of the gallbladder are common and costly. The best epidemiological screening method to accurately determine point prevalence of gallstone disease is ultrasonography. Many risk factors for cholesterol gallstone formation are not modifiable such as ethnic background, increasing age, female gender and family history or genetics. Conversely, the modifiable risks for cholesterol gallstones are obesity, rapid weight loss and a sedentary lifestyle. The rising epidemic of obesity and the metabolic syndrome predicts an escalation of cholesterol gallstone frequency. Risk factors for biliary sludge include pregnancy, drugs like ceftiaxone, octreotide and thiazide diuretics, and total parenteral nutrition or fasting. Diseases like cirrhosis, chronic hemolysis and ileal Crohn's disease are risk factors for black pigment stones. Gallstone disease in childhood, once considered rare, has become increasingly recognized with similar risk factors as those in adults, particularly obesity. Gallbladder cancer is uncommon in developed countries. In the U.S., it accounts for only ~ 5,000 cases per year. Elsewhere, high incidence rates occur in North and South American Indians. Other than ethnicity and female gender, additional risk factors for gallbladder cancer include cholelithiasis, advancing age, chronic inflammatory conditions affecting the gallbladder, congenital biliary abnormalities, and diagnostic confusion over gallbladder polyps.

Keywords: Cholecystectomy; Gallbladder cancer; Gallbladder polyps; Gallstones.

Fig. 1

Worldwide prevalence of gallstones in females based on ultrasonographic surveys varies. Prevalence is inordinately high in American Indians and their admixtures, and also Northern Europeans; somewhat lower in European and American whites; intermediate in Asians and black Americans, and quite low in black Africans.

Fig. 2

Incidence of gallbladder cancer worldwide (From National Cancer Institute. Surveillance, Epidemiology and End Results (SEER) Program. Available from http://seer.cancer.gov/). Carcinoma of the gallbladder is more common in certain ethnic groups: native American Indians, white Hispanics from North and South America, and those from northern India and Eastern Europe. Elsewhere in the world, the incidence is low at <2/100,000.