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Cholesterol gallstones: from epidemiology to prevention
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  1. M Acalovschi
  1. University of Medicine and Pharmacy, Cluj-Napoca, Romania
  1. Professor Monica Acalovschi, 3rd Medical Clinic, University of Medicine and Pharmacy, Str Iuliu Maniu No 9, 3400 Cluj-Napoca, Romania

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Gallstones are a major public health problem in all developed countries. Many epidemiological studies have been performed with the aim of establishing gallstone prevalence and incidence rates, and of defining risk factors, amenable to prevention. Cholesterol gallstones constitute more than 80% of stones in the Western world.

Epidemiology

The data usually employed in assessing gallstone prevalence were derived until recently from selected series of patients (necropsies, surgery, etc), which may not represent the general population. Suffice to say that the reported 0% prevalence of gallstones in the Masaï population was deduced from surgical experience in that area, which is far from being an ideal way to collect epidemiological data.

Necropsy studies are subject to selection bias, which can be reduced by adjusting the data by standardisation. Necropsy studies have shown that, even after standardisation for age and sex, there are major differences between different countries (table 1). The available necropsy data, scrutinising longer intervals of time, decades1 2 or even a century,3 have revealed a trend of increasing gallstone prevalence.

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Table 1

Age standardised necropsy prevalence of gallstones (see p 228 for list of references)

Cholecystectomy rates, which fluctuate considerably (as much as fivefold) between countries and periods of time, have little relation to the prevalence rates. Oral cholecystography has been used by several researchers to assess gallstone prevalence, but no satisfactory evaluation on the prevalence of silent gallstones in the population was achieved.

Currently, most studies have used real time ultrasonography as a screening method in randomly selected populations. Ultrasonography does not only allow the assessment of prevalence, but it is also suitable for follow up in order to establish gallstone incidence and to define risk factors for gallstone disease.

Accurate data for local gallstone prevalence and incidence rates are not yet available for every country. The largest number of …

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