Chronological changes in epidemiologic features of patients with gallstones over the last 20 years in a single large-volume Korean center

Abstract

Purpose: South Korea has a high prevalence of gallstones, the type of which could be influenced by changes in diet and socioeconomic status. Here we aimed to investigate the epidemiological characteristics and changing patterns of gallstones over the past 20 years in Korea.

Methods: A total of 5,808 patients who underwent cholecystectomy due to gallstones at Seoul National University Hospital between 1996 and 2015 were analyzed. Patients were divided into 4 subgroups: period 1 (1996-2000, n = 792), period 2 (2001-2005, n = 1,215), period 3 (2006-2010, n = 1,525), period 4 (2011-2015, n = 2,276). Gallstones were classified by type: pure cholesterol (PC), mixed cholesterol (MC), calcium bilirubinate (CB), black pigment (BP), and combination (COM).

Results: The female to male ratio was 1.16 with mean ages of 53.6 and 55.3 years old, respectively. The ratio of cholesterol stones to pigment stones was 0.96:1. The mean age and male to female ratio of the patients increased over time. The proportion of cholesterol vs pigment stone did not differ significantly. Proportions of PC and MC stone subtypes did not change notably, whereas proportion of BP stones increased (34.0% to 45.5%), and CB stones decreased (20.7% to 5.3%).

Conclusion: Gallstone types and occurrences were affected by environmental changes, and pigment stones remained common in Korea. Although no distinct increase in cholesterol stones was noted, the proportion of CB stones decreased. As the mean age at gallstone presentation increases, BP stones could become more prevalent.

Keywords: Cholecystolithiasis; Cholelithiasis; Classification; Gallstones.

Fig. 1. Chronological changes of the proportions by types of gallstone. BP, black pigment; MC, mixed cholesterol; PC, pure cholesterol; CB, calcium bilirubinate; COM, combination.

Fig. 2. Chronological changes of the mean ages (A) by pigment versus cholesterol types and (B) by 5 subtypes of gallstones. CB, calcium bilirubinate; BP, black pigment; COM, combination; MC, mixed cholesterol; PC, pure cholesterol.

Fig. 3. Chronological changes of the proportions by types of gallstones in males (A), females (B), urban (C), and rural (D) area. BP, black pigment; MC, mixed cholesterol; PC, pure cholesterol; CB, calcium bilirubinate; COM, combination.