Clinical Characteristics and Risk Factors for Symptomatic Pediatric Gallbladder Disease
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
ARTICLE Clinical Characteristics and Risk Factors for Symptomatic Pediatric Gallbladder Disease AUTHORS: Seema Mehta, MD,a Monica E. Lopez, MD,b WHAT’S KNOWN ON THIS SUBJECT: Gallbladder disease in Bruno P. Chumpitazi, MD,a Mark V. Mazziotti, MD,b children is an evolving entity and studies suggest an increasing Mary L. Brandt, MD,b and Douglas S. Fishman, MDa frequency of symptomatic pediatric gallbladder disease and aDepartment of Pediatrics, Baylor College of Medicine, Section of resultant cholecystectomies. Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, Texas; bMichael E. DeBakey Department of WHAT THIS STUDY ADDS: Hispanic ethnicity and obesity are Surgery, Baylor College of Medicine; Division of Pediatric Surgery, Texas Children’s Hospital, Houston, Texas epidemiologically significant risk factors for symptomatic gallbladder disease in the pediatric population. KEY WORDS children, cholecystectomy, gallbladder, Hispanic, obesity ABBREVIATIONS ERCP—endoscopic retrograde cholangiopancreatography HIDA—hepatobiliary iminodiacetic acid IOC—intraoperative cholangiogram TCH—Texas Children’s Hospital abstract OBJECTIVE: Our center previously reported its experience with pedi- All authors contributed extensively to this study. Drs Mehta, Lopez, Brandt, and Fishman conceived and designed the study. atric gallbladder disease and cholecystectomies from 1980 to 1996. We Drs Mehta, Lopez, and Fishman acquired the data. Drs Mehta, aimed to determine the current clinical characteristics and risk fac- Chumpitazi, and Fishman analyzed and interpreted the data. Drs tors for symptomatic pediatric gallbladder disease and cholecystecto- Mehta, Brandt, and Fishman drafted the manuscript. All authors contributed to critical revisions of the manuscript and gave final mies and compare these findings with our historical series. approval of the version to be published. STUDY DESIGN: Retrospective, cross-sectional study of children, 0 to 18 www.pediatrics.org/cgi/doi/10.1542/peds.2011-0579 years of age, who underwent a cholecystectomy from January 2005 to doi:10.1542/peds.2011-0579 October 2008. Accepted for publication Sep 9, 2011 RESULTS: We evaluated 404 patients: 73% girls; 39% Hispanic and 35% Address correspondence to Seema Mehta, MD, 6621 Fannin white. The mean age was 13.10 6 0.91 years. The primary indications Street, CC1010.02, Houston, TX 77030. E-mail: seemam@bcm.edu for surgery in patients 3 years or older were symptomatic cholelithi- PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). asis (53%), obstructive disease (28%), and biliary dyskinesia (16%). Copyright © 2012 by the American Academy of Pediatrics The median BMI percentile was 89%; 39% were classified as obese. Of FINANCIAL DISCLOSURE: The authors have indicated they have the patients with nonhemolytic gallstone disease, 35% were obese and no financial relationships relevant to this article to disclose. 18% were severely obese; BMI percentile was 99% or higher. Gallstone disease was associated with hemolytic disease in 23% (73/324) of patients and with obesity in 39% (126/324). Logistic regression demonstrated older age (P = .019) and Hispanic ethnicity (P , .0001) as independent risk factors for nonhemolytic gallstone disease. Compared with our historical series, children undergoing cholecystectomy are more likely to be Hispanic (P = .003) and severely obese (P , .0279). CONCLUSION: Obesity and Hispanic ethnicity are strongly correlated with symptomatic pediatric gallbladder disease. In comparison with our historical series, hemolytic disease is no longer the predominant risk factor for symptomatic gallstone disease in children. Pediatrics 2012;129:1–7 PEDIATRICS Volume 129, Number 1, January 2012 1 Downloaded from by guest on November 4, 2015
Gallbladder disease in children is We hypothesize that the epidemiologic Nutrition and Research Center com- evolving and studies suggest an ever- risk factors for pediatric gallbladder puterized calculator, which is based increasing frequency of gallbladder disease now resemble those seen in on the Centers for Disease Control disease and resultant cholecystecto- adults (eg, female gender, race, and and Prevention’s standardized charts mies in children.1–8 In 1959, the pre- obesity).19,25–28 In this retrospective (http://www.bcm.edu/cnrc/bodycomp/ valence of cholelithiasis in children series of consecutive children under- bmiz2.html). BMI percentiles were cat- younger than 16 years was noted to be going cholecystectomy, we aimed to egorized as follows: lower than 85%, 0.15%.9 Since that time, the prevalence identify the clinical characteristics and normal weight; 85% to 94.9%, over- has increased with estimates ranging risk factors for pediatric gallbladder weight; 95% to 98.9%, obese; and 99% from 1.9% to 4.0%.3–6 The number of disease resulting in cholecystectomy or higher, severely obese. cholecystectomies has increased ac- and to compare current demographics SPSS 17.0 (Chicago, IL) was used for all cordingly. At our own institution, 36 cho- and indications for surgery with our statistical analyses. Comparison of lecystectomies were performed from historical series.1 categorical values between groups was 1960 to 1980, and 128 were performed done via x 2 analyses. Comparison of over the next 17 years (1980–1997).1,10 METHODS continuous variables between groups Cholelithiasis in infancy is typically re- The Texas Children’s Hospital (TCH) pa- was completed with Mann-Whitney lated to prematurity, total parenteral thology database was used to identify U analysis. Binary multivariate logistic nutrition use, abdominal surgery, or all patients, 0 to 18 years of age, who regression analysis with presence or sepsis.2,11–13 During adolescence, pre- underwent a cholecystectomy from absence of gallstone disease as the vious reports identified hemolytic dis- January 2005 through October 2008. All dependent variable was completed. A ease as the most common associated patients who underwent an incidental P value # .05 was used to indicate comorbidity. More recent data sug- cholecystectomy secondary to liver statistical significance. Z-scores were gest that gallbladder disease related transplantation or hepatobiliary sur- used for all statistical analyses of BMI. to nonhemolytic risk factors, including gery (eg, Kasai portoenterostomy) were BMI was not calculated for patients pregnancy, oral contraceptive use, and excluded. younger than 3 years because only a obesity, is on the rise.1,2,14–16 length was available for these patients, The medical records of study patients not a height; therefore, these patients The change in etiology of gallbladder were examined for demographics (age, were excluded from BMI analyses.29 disease is temporally related to the gender, race/ethnicity), anthropomor- well-documented rise in childhood phic measurements (weight, height), Hemolytic disease is a well-described, obesity. The NHANES data from 2003 to comorbidities, primary and secondary strong independent risk factor for 2004 revealed the prevalence of child- indications for cholecystectomy, find- cholelithiasis; therefore, patients with hood obesity in the United States to be ings on imaging studies (hepatobiliary hemolytic disease (sickle cell anemia, 17.1%, compared with 13.9% from 1999 iminodiacetic acid [HIDA] scan, abdo- hereditary spherocytosis, hemoglobin to 2000.17 In addition, the prevalence of minal ultrasound, magnetic resonance H disease, autoimmune hemolytic ane- severe obesity, BMI percentile of 99% cholangiopancreatography) and/or mia, congenital dyserythropoietic ane- or higher, increased by more than endoscopic retrograde cholangio- mia) were excluded when assessing the 300%: 0.8% from 1976 to 2000 to 3.8% pancreatography (ERCP), and histo- impact of other potential risk factors, from 1999 to 2004.18 Severe obesity was pathology. Patients were identified as age, gender, BMI, and race, on gallstone noted to be the highest among African having a primary indication of compli- formation.30–33 American and Hispanic individuals.18 cated obstructive disease if they were RESULTS The relationship between obesity and diagnosed with gallstone pancreatitis, gallbladder disease is well recognized in jaundice, choledocholithiasis, or found Patient Population the adult population.19,20 Obesity has to have dilation of the common bile duct A total of 455 cholecystectomies were previously been described as a rare risk on an imaging study. This study was completed at TCH from January 2005 to factor for gallbladder disease in chil- conducted after approval from the October 2008. Of these, 404 patients met dren; however, as a result of the obesity Baylor College of Medicine Institutional inclusion criteria (Fig 1). Demographic epidemic, obesity-related comorbidities, Review Board. data for these patients are shown in including gallbladder disease, are in- BMI (kg/m2), Z-scores, and BMI per- Table 1. The BMI distribution of all creasingly affecting the pediatric pop- centiles were calculated using the patients $3 years of age was as follows: ulation.1,2,13,14,21–24 Baylor College of Medicine Children’s 45% (n = 174) were considered to be 2 MEHTA et al Downloaded from by guest on November 4, 2015
ARTICLE TABLE 2 Primary Comorbidities Hemolytic disease 76 (19%) Obesity 18 (4%) Post partum 14 (3%) Malignancy 9 (2%) Polycystic ovary syndrome 6 (2%) Thyroid disease 5 (2%) Cardiac disease 7 (1.5%) Diabetes 5 (1%) Prematurity 4 (1%) Hyperlipidemia 4 (1%) Cystic fibrosis 2 (0.5%) FIGURE 1 Gilbert disease 1 (0.2%) Excluded patients. Others 38 (9%) None 216 TABLE 1 Demographics (n = 2). A primary indication was not Age, y identified for one patient. For those 3 to 7 years old, and 3% (n = 7) were Range 0.6–18.0 patients younger than 3 years, symp- younger than 3 years. Most of the Mean 13 Median 14 tomatic cholelithiasis (n = 5, 71%) and patients (76%, n = 190) were girls. Age categories, n (%) complicated obstructive disease (n = 2, For patients $3 years old with non- 13–18 y 271 (67) 29%) were the primary indications for hemolytic gallstone disease (n = 244), 8–12 y 88 (22) surgery. Gallstones were identified on the BMI percentile distribution was as 3–7 y 38 (9) Younger than 3 y 7 (2) gross pathology or imaging in 80% follows: 31% (n = 74) were considered Gender (324/404) of patients. None of the pa- to be a normal weight, 16% (n = 37) Males, n (%) 111 (27) tients with biliary dyskinesia (n = 64) Females, n (%) 293 (73) were overweight, 35% (n = 82) were Male:Female 1.0:2.6 or gallbladder polyps (n = 3) had evi- obese, and 18% (n = 44) were severely Race/Ethnicity, n (%) dence of gallstones. obese. As such, ∼69% (n = 163/237) of Hispanic 144 (39) White 126 (35) Patients with complicated obstructive patients with gallstone disease were African American 90 (25) disease (n = 112) presented with one or overweight or obese. The median BMI Other 5 (1) a combination of the following: chol- percentile for these patients was 95% Unknown 39 (10) edocholithiasis (n = 43), gallstone pan- and the mean BMI percentile was 81%. A creatitis (n = 42), jaundice (n = 16), and height or weight was absent for 7 pa- a normal weight, 16% (n = 63) were dilation of the common bile duct (n = 64). tients with gallstone disease; therefore, overweight, 24% (n = 94) were obese, More than one-third of patients with these patients were excluded from all and 15% (n = 57) were severely obese. complicated obstructive disease (n = 42; BMI analyses. The median BMI percentile was 89%. 38%) presented with a combination of Logistic regression was used to predict Of the patients with a BMI percentile obstructive findings. the impact of gender, age, BMI, and $95%, 52% (n = 79) were Hispanic. A Associated comorbidities were identi- Hispanic ethnicity on the incidence of height or weight was unavailable for fied for 189 (47%) of 404 patients. These nonhemolytic gallstone disease. Older 9 patients; therefore, these patients are listed in Table 2. A positive family age (P = .019) and Hispanic ethnicity were excluded from all BMI analyses. history of cholelithiasis was reported (P , .0001) were independent risk for only 9 patients. factors for nonhemolytic gallstone dis- Indications ease. Gender and BMI percentile were The primary indications for cholecys- Gallstone Disease: Risk Factors not independent risk factors. tectomy in patients $3 years of age Of the 76 children with hemolytic dis- were symptomatic cholelithiasis (n = ease, 73 (96%) were diagnosed with Complicated Obstructive Disease 211; 53%), complicated obstructive gallstone disease. Nonhemolytic gall- Complicated obstructive disease was disease (n = 112; 28%), and biliary stone disease occurred in 77% (251/ the primary indication for a cholecys- dyskinesia (n = 64; 16%). Other indi- 324) of patients. The age distribution tectomy in 112 patients $3 years of age. cations included acalculous cholecys- of patients with nonhemolytic gallstone Of these, 61 had a BMI percentile $85% titis (n = 4), gallbladder polyps (n = 3), disease was as follows: 76% (n = 192) (P = .496). Univariate analysis identified and persistent right upper quadrant were 13 to 18 years old, 16% (n = 39) a significant association between the abdominal pain of unknown etiology were 8 to 12 years old, 5% (n = 13) were risk for gallstone pancreatitis and a BMI PEDIATRICS Volume 129, Number 1, January 2012 3 Downloaded from by guest on November 4, 2015
percentile $85% (P = .003); however, children with hemolytic disease. The complications were postoperative fever this association was not found for overall percentage of patients with and pancreatitis/pseudocyst formation jaundice (P = not significant). Hispanic hemolytic disease as an indication for (Table 4). Of the obese patients, 15% (n = patients (n = 55, 65%) were more likely cholecystectomy has decreased sig- 23) had a minor or major postoperative than non-Hispanic patients (n = 29, nificantly (41% vs 18%, P , .0001). complication (P = .4). No deaths oc- 35%) to have obstructive disease (P = Additionally, no cholecystectomies were curred as a result of a cholecystectomy .005). Of the 112 patients with compli- previously performed for biliary dyski- in our current series. In our previous cated obstructive disease, 56% (n = 63) nesia, whereas now it is the third lead- series, 3 children with congenital heart underwent the following additional ing indication (0% vs 16%, P , .0001). disease who required emergent chole- procedures: ERCP (n = 21), intraop- Another significant change has been in cystectomy died after surgery.1 erative cholangiogram (IOC) (n = 28), the approach to surgery. In our current or ERCP and IOC (n = 14). series, 97% of cholecystectomies were DISCUSSION performed laparoscopically versus 15% We have found that cholecystectomies Biliary Dyskinesia in our previous series. The major com- for gallbladder disease are performed Biliary dyskinesia, by definition, is a plication rate remains similar (9% vs more often in children and the risk gallbladder ejection fraction of ,35% 9%) (Table 3). The most common major factors for cholecystectomies have with a cholecystokinin analog infusion on HIDA scan.34–37 Biliary dyskinesia was TABLE 3 Texas Children’s Hospital Historical Comparison1 the third leading indication for a cho- 1980–1996 2005–2008 P Value lecystectomy in our patient cohort. Total no. of patients 128 404 Females comprised 78% of these Age, y patients, and 18% were of Hispanic eth- Mean 10 13.00 6 0.19 nicity. Fifty-one percent of patients were Gender Males 59 (46%) 111 (27%) .0001 overweight and, of these, 30% were Females 69 (54%) 293 (73%) .0001 severely obese. HIDA scans completed Male:Female 0.8:1 1:2.6 on all 64 patients revealed an ejection Race/Ethnicity fraction of less than 35% (median of Hispanic 28 (22%) 144 (36%) .003 White 57 (45%) 126 (31%) NS 10%; range 0%–34%). Histologic fea- African American 39 (30%) 90 (22%) NS tures of chronic cholecystitis were Other 4 (3%) 5 (1%) NS identified in 80% (n = 51) of patients BMI Severely obese 8 (6%) 57 (15%) .013 with a preoperative diagnosis of biliary Comorbidities dyskinesia. Hemolytic disease 52 (41%) 76 (19%) ,.0001 Biliary dyskinesia 0 64 (16%) ,.0001 Surgery Comparison With Historical Control Laparoscopic 19 (15%) 379 (96%) ,.0001 Miltenburg et al published data on pe- Open 109 (85%) 17 (4%) ,.0001 Major complication 11 (9%) 38 (9%) NS diatric cholecystectomies at TCH from NS, not significant. 1980 to 1996.1 We compared our data with this historical cohort (Table 3). There has been a notable increase in TABLE 4 Postoperative Complications From the 2005–2008 Texas Children’s Hospital Cohort the percentage of Hispanic (22% vs Major (n) Minor (n) 36%, P = .003) and severely obese (6% Postoperative fever (8) Abdominal pain (13) vs 18%, P , .027) patients undergoing Pancreatitis/pseudocyst formation (7) Nausea/Vomiting (nonbilious) (6) cholecystectomy. Patients in the his- Infection (eg, fungemia, urinary tract infection, Ileus (2) torical cohort were subjectively cate- wound infection) (5) Papillary stenosis/stricture (4) gorized as being morbidly obese. BMI Retained stone (4) data for this historical cohort of Jaundice (4) patients was not available for direct Bile leak (2) comparison. Vascular injury (1) Hemobilia (1) In our historical series, 52 (41%) of 128 Small bowel obstruction (1) cholecystectomies were performed on Prolonged intubation (1) 4 MEHTA et al Downloaded from by guest on November 4, 2015
ARTICLE changed. In the initial series from TCH, dyskinesia, 78% were female and 70% not previously been investigated. De- 36 cholecystectomies were performed were $13 years of age. These findings spite 25% of the Hispanic children in 20 years (1.8 per year), followed by may support the suggestion that the being overweight or obese, we dem- 128 in next 17 years (7.5 per year), and hormonal changes occurring during onstrate that independent of their BMI now 404 in almost 4 years (101 per puberty may contribute to the impair- percentiles, Hispanic children are at year).1,10 Previously described risk ment of gallbladder motility in biliary a greater risk for cholecystectomy be- factors such as prematurity (n = 4, 1%) dyskinesia by altering the lipid com- cause of gallstone disease. This finding and hemolytic disease (n = 76, 19%) did position of bile, increasing cholesterol supports the possible genetic risk not account for this dramatic increase. saturation, and promoting gallbladder predisposition for stone formation in Rather, risk factors responsible for the hypomotility.43,45,46 Hispanic children similar to that seen development of gallbladder disease in We also demonstrate a strong inde- in Hispanic adults.52 Interestingly, we adults (female gender, age, obesity, pendent correlation between BMI per- identified only 9 patients, of whom only and ethnicity) were identified as key centile and the presence of gallstone 5 were Hispanic, with a positive family contributors to this increase in pedi- disease. Based on their BMI, a remark- history of cholelithiasis. We anticipate atric gallbladder disease resulting in able 69% of our patients with non- that a positive family history may have cholecystectomy. hemolytic gallstone disease were been underreported or family mem- Our study mirrors previous observa- overweight or obese; however, only 6% bers may have asymptomatic choleli- tions that female children are at higher of our patients had “obesity” docu- thiasis. As such, race/ethnicity may be risk of gallbladder disease than male mented with an International Classifi- a greater risk factor for gallstone dis- children.1,2,7 A greater proportion of cation of Diseases, Ninth Revision ease than obesity alone. Further stud- patients in our series were female code as a comorbidity in their medical ies examining the independent risk of (73%, n = 293), reflecting the trend to- record, demonstrating a significant race/ethnicity on the development of ward gender bias. In adults, the high underreporting of this condition. Obe- gallstone disease are needed. prevalence of cholelithiasis in women sity is a major health care issue and its To our knowledge, this is the largest has been attributed to pregnancy and contribution to the prevalence of cho- single-center study examining gall- oral contraceptive use.38–43 We identi- lelithiasis has been well elucidated bladder disease in children who un- fied 14 women with a documented in the adult population.19,20,27,28 The derwent a cholecystectomy. Bogue et al8 pregnancy; however, our study design pathogenesis of gallstone formation in recently studied 382 patients diag- precluded the evaluation of patients obese individuals has been described nosed with cholelithiasis based on taking oral contraceptives. as multifactorial with key factors, in- ultrasonography. In this series, only We found an increase in the mean age of cluding hepatic hypersecretion of 122 patients underwent a cholecystec- diagnosis for gallstone disease. The cholesterol with resultant supersatu- tomy. The racial and ethnic distribution previous mean age for children with ration of bile and altered gallbladder of their study population and its impact gallstone disease has ranged from 8.4 motility.20,27,47 Our study strongly sug- on the development of cholelithiasis to 10.0 years; however, our mean age gests the obesity epidemic in children was not described. Obesity was iden- was notably higher at 13.0 years1,2 has contributed significantly to the tified in a significantly lower percent- (67% were 13 to 18 years of age). This striking increase in pediatric gallstone age of patients than our study population, phenomenon has previously been disease. ,1% vs 53%. In addition, we report a suggested and attributed to biliary Our data suggest that Hispanic ethnic- higher rate of complicated disease in cholesterol saturation occurring sec- ity is also a significant risk factor for patients requiring surgery, 10% vs 28%; ondary to hormonal changes during pediatric gallbladder disease resulting however, the definitions for compli- puberty.43,44 An increase in the mean in cholecystectomy. It has previously cated disease varied between studies. age at diagnosis may also be attribut- been shown that Hispanic adults are at Our definition did not include acute able to the rising incidence of obesity in increased risk for cholelithiasis.48–51 cholecystitis, whereas Bogue et al8 did adolescents. Genetic and environmental influences not include jaundice or dilation of the The hormonal changes associated with have been explored as potential ex- common bile duct. puberty may also play a role in the planations for this epidemiologic as- Our study’s major strengths are a large etiology of biliary dyskinesia. Of the sociation.48,49,52,53 The impact of racial sample size and diverse patient pop- patients who underwent a cholecystec- and ethnic variations on gallbladder ulation. The study is limited by its ret- tomy for the primary indication of biliary disease in the pediatric population has rospective design. At the time of our PEDIATRICS Volume 129, Number 1, January 2012 5 Downloaded from by guest on November 4, 2015
final analysis, some data, including historical cohort and current patient cholecystectomies to laparoscopic a height or weight for 9 of 404 patients, population may have been influenced cholecystectomies. a race or ethnicity for 39 of 404, and an by the changing demographics of indication for cholecystectomy for 1 Houston and advances in medical care. CONCLUSION patient, were missing. We believe that The Hispanic population of Houston, Hispanic ethnicity and obesity are given our large sample size, the miss- Texas, has been steadily increasing epidemiologically significant risk fac- ing data would not have significantly since 1980.54 This demographic change tors for gallbladder disease in the altered our results. Additionally, BMI pediatric population. Ethnicity is an likely contributed to the increase in data for our historical cohort was not unalterable risk factor, but increased the proportion of Hispanic children available for direct comparison. With awareness and early screening by our stringent search criteria, all patients undergoing cholecystectomies. We also pediatric health care providers could who underwent a cholecystectomy surmise that biliary dyskinesia was potentially limit the occurrence of during our study period should be identified as the third leading indication complicated obstructive disease. Ob- represented; however, patients with for cholecystectomy in our cohort sec- esity is a modifiable risk factor. With gallbladder disease who did not have ondary to the rising awareness of the the prevalence of childhood obesity on a cholecystectomy were not included in disease in the pediatric population.55,56 the rise, pediatric health care pro- our epidemiologic data.30 In addition, the significant difference in viders need to be more aware of We recognize that some of the notable surgical practice is likely a reflection of obesity-related comorbidities, includ- differences identified between our the shift in standard of care from open ing gallbladder disease. REFERENCES 1. Miltenburg DM, Schaffer R, III, Breslin T, 9. Glenn F. 25-years experience in the surgical bile acids in paediatric gallstones. Dig Liver Brandt ML. Changing indications for pedi- treatment of 5037 patients with non- Dis. 2010;42(1):61–66 atric cholecystectomy. Pediatrics. 2000;105 malignant biliary tract disease. Surg Gynecol 17. Ogden CL, Carroll MD, Curtin LR, McDowell (6):1250–1253 Obstet. 1959;109:591–606 MA, Tabak CJ, Flegal KM. Prevalence of 2. Friesen CA, Roberts CC. Cholelithiasis. 10. Pokorny WJ, Saleem M, O’Gorman RB, overweight and obesity in the United States, Clinical characteristics in children. Case McGill CW, Harberg FJ. Cholelithiasis and 1999-2004. JAMA. 2006;295(13):1549–1555 analysis and literature review. Clin Pediatr cholecystitis in childhood. Am J Surg. 1984; 18. Skelton JA, Cook SR, Auinger P, Klein JD, (Phila). 1989;28(7):294–298 148(6):742–744 Barlow SE. Prevalence and trends of severe 3. Shafer AD, Ashley JV, Goodwin CD, Nangas 11. Roslyn JJ, Berquist WE, Pitt HA, et al. In- obesity among US children and adoles- VN Jr, Elliott D. A new look at the multi- creased risk of gallstones in children re- cents. Acad Pediatr. 2009;9(5):322–329 factorial etiology of gallbladder disease in ceiving total parenteral nutrition. Pediatrics. 19. Shaffer EA. Epidemiology and risk factors children. Am Surg. 1983;49(6):314–319 1983;71(5):784–789 for gallstone disease: has the paradigm 4. Wesdorp I, Bosman D, de Graaff A, Aronson 12. King DR, Ginn-Pease ME, Lloyd TV, Hoffman changed in the 21st century? Curr Gastro- D, van der Blij F, Taminiau J. Clinical pre- J, Hohenbrink K. Parenteral nutrition with enterol Rep. 2005;7(2):132–140 sentations and predisposing factors of cho- associated cholelithiasis: another iatrogenic 20. Bennion LJ, Grundy SM. Effects of obesity lelithiasis and sludge in children. J Pediatr disease of infants and children. J Pediatr and caloric intake on biliary lipid metabolism Gastroenterol Nutr. 2000;31(4):411–417 Surg. 1987;22(7):593–596 in man. J Clin Invest. 1975;56(4):996–1011 5. Lobe TE. Cholelithiasis and cholecystitis in 13. Debray D, Pariente D, Gauthier F, Myara A, 21. Freedman DS, Dietz WH, Srinivasan SR, children. Semin Pediatr Surg. 2000;9(4): Bernard O. Cholelithiasis in infancy: a Berenson GS. The relation of overweight to 170–176 study of 40 cases. J Pediatr. 1993;122(3): cardiovascular risk factors among children 6. Calabrese C, Pearlman DM. Gallbladder 385–391 and adolescents: the Bogalusa Heart Study. disease below the age of 21 years. Surgery. 14. Holcomb GW, Jr,O’Neill JA, Jr,Holcomb GW III. Pediatrics. 1999;103(6 Pt 1):1175–1182 1971;70(3):413–415 Cholecystitis, cholelithiasis and common 22. American Diabetes Association. Type 2 di- 7. Herzog D, Bouchard G. High rate of com- duct stenosis in children and adolescents. abetes in children and adolescents. Pedi- plicated idiopathic gallstone disease in Ann Surg. 1980;191(5):626–635 atrics. 2000;105(3 Pt 1):671–680 pediatric patients of a North American ter- 15. Kaechele V, Wabitsch M, Thiere D, et al. 23. Mallory GB, Jr,Fiser DH, Jackson R. Sleep- tiary care center. World J Gastroenterol. 2008; Prevalence of gallbladder stone disease in associated breathing disorders in morbidly 14(10):1544–1548 obese children and adolescents: influence obese children and adolescents. J Pediatr. 8. Bogue CO, Murphy AJ, Gerstle JT, Moineddin of the degree of obesity, sex, and pubertal 1989;115(6):892–897 R, Daneman A. Risk factors, complications, development. J Pediatr Gastroenterol Nutr. 24. Quiros-Tejeira RE, Rivera CA, Ziba TT, et al. and outcomes of gallstones in children: 2006;42(1):66–70 Risk for nonalcoholic fatty liver disease in a single-center review. J Pediatr Gastro- 16. Koivusalo AI, Pakarinen MP, Sittiwet C, et al. Hispanic youth with BMI $95th percentile. enterol Nutr. 2010;50(3):303–308 Cholesterol, non-cholesterol sterols and Hepatology. 2006;44(2):228–236 6 MEHTA et al Downloaded from by guest on November 4, 2015
ARTICLE 25. Attili AF, Capocaccia R, Carulli N, et al; 36. Al-Homaidhi HS, Sukerek H, Klein M, Tolia V. 47. Marschall H-U, Einarsson C. Gallstone dis- Multicenter Italian Study on Epidemiology Biliary dyskinesia in children. Pediatr Surg ease. J Intern Med. 2007;261(6):529–542 of Cholelithiasis. Factors associated with Int. 2002;18(5-6):357–360 48. Maurer KR, Everhart JE, Ezzati TM, et al. gallstone disease in the MICOL experience. 37. Hansel SL, DiBaise JK. Functional gallblad- Prevalence of gallstone disease in Hispanic Hepatology. 1997;26(4):809–818 der disorder: gallbladder dyskinesia. Gas- populations in the United States. Gastro- 26. Klein S, Wadden T, Sugerman HJ. AGA troenterol Clin North Am. 2010;39(2):369– enterology. 1989;96(2 Pt 1):487–492 technical review on obesity. Gastroenterol- 379, x 49. Everhart JE, Khare M, Hill M, Maurer KR. ogy. 2002;123(3):882–932 38. Bennion LJ, Ginsberg RL, Gernick MB, Bennett Prevalence and ethnic differences in gall- 27. Dittrick GW, Thompson JS, Campos D, PH. Effects of oral contraceptives on the bladder disease in the United States. Gas- Bremers D, Sudan D. Gallbladder pathology gallbladder bile of normal women. N Engl troenterology. 1999;117(3):632–639 in morbid obesity. Obes Surg. 2005;15(2): J Med. 1976;294(4):189–192 50. Méndez-Sánchez N, King-Martínez AC, 238–242 39. Cirillo DJ, Wallace RB, Rodabough RJ, et al. Ramos MH, Pichardo-Bahena R, Uribe M. 28. Shaffer EA. Gallstone disease: epidemiol- Effect of estrogen therapy on gallbladder The Amerindian’s genes in the Mexican ogy of gallbladder stone disease. Best disease. JAMA. 2005;293(3):330–339 population are associated with development Pract Res Clin Gastroenterol. 2006;20(6): 40. Valdivieso V, Covarrubias C, Siegel F, Cruz F. of gallstone disease. Am J Gastroenterol. 981–996 Pregnancy and cholelithiasis: pathogenesis 2004;99(11):2166–2170 29. Centers for Disease Control and Pre- and natural course of gallstones diagnosed in 51. Diehl AK, Stern MP. Special health problems vention. Growth charts. Available at: www. early puerperium. Hepatology. 1993;17(1):1–4 of Mexican-Americans: obesity, gallbladder cdc.gov/growthcharts/. Accessed February 41. Ko CW, Beresford SAA, Schulte SJ, Matsumoto disease, diabetes mellitus, and cardiovascu- 22, 2011 AM, Lee SP. Incidence, natural history, and lar disease. Adv Intern Med. 1989;34:73–96 30. Suell MN, Horton TM, Dishop MK, Mahoney risk factors for biliary sludge and stones 52. Puppala S, Dodd GD, Fowler S, et al. A DH, Olutoye OO, Mueller BU. Outcomes for during pregnancy. Hepatology. 2005;41(2): genomewide search finds major suscepti- children with gallbladder abnormalities 359–365 bility loci for gallbladder disease on chro- and sickle cell disease. J Pediatr. 2004;145 42. Thijs C, Knipschild P. Oral contraceptives mosome 1 in Mexican Americans. Am J (5):617–621 and the risk of gallbladder disease: a meta- Hum Genet. 2006;78(3):377–392 31. Rennels MB, Dunne MG, Grossman NJ, analysis. Am J Public Health. 1993;83(8): 53. Katsika D, Grjibovski A, Einarsson C, Lammert Schwartz AD. Cholelithiasis in patients with 1113–1120 F, Lichtenstein P, Marschall HU. Genetic and major sickle hemoglobinopathies. Am J Dis 43. Wang HH, Liu M, Clegg DJ, Portincasa P, environmental influences on symptomatic Child. 1984;138(1):66–67 Wang DQ. New insights into the molecular gallstone disease: a Swedish study of 32. Karayalcin G, Hassani N, Abrams M, mechanisms underlying effects of estrogen 43,141 twin pairs. Hepatology. 2005;41(5): Lanzkowsky P. Cholelithiasis in children with on cholesterol gallstone formation. Biochim 1138–1143 sickle cell disease. Am J Dis Child. 1979;133 Biophys Acta. 2009;1791(11):1037–1047 54. City of Houston Planning and Development (3):306–307 44. Kern F, Jr,Everson GT, DeMark B, et al. Biliary Department. Demographic data. Available at: 33. Al-Salem AH, Qaisaruddin S, Al-Dabbous I, lipids, bile acids, and gallbladder function in www.houstontx.gov/planning/Demographics/ et al. Cholelithiasis in children with sickle the human female. Effects of pregnancy and demog_links.html. Accessed February 22, cell disease. Pediatr Surg Int. 1996;11(7): the ovulatory cycle. J Clin Invest. 1981;68(5): 2011 471–473 1229–1242 55. Haricharan RN, Proklova LV, Aprahamian CJ, 34. Ozden N, DiBaise JK. Gallbladder ejection 45. Von Bergmann K, Becker M, Leiss O. Biliary et al. Laparoscopic cholecystectomy for fraction and symptom outcome in patients cholesterol saturation in non-obese women biliary dyskinesia in children provides du- with acalculous biliary-like pain. Dig Dis and non-obese men before and after pu- rable symptom relief. J Pediatr Surg. 2008; Sci. 2003;48(5):890–897 berty. Eur J Clin Invest. 1986;16(6):531–535 43(6):1060–1064 35. Vegunta RK, Raso M, Pollock J, et al. Biliary 46. Bennion LJ, Knowler WC, Mott DM, Spagnola 56. Scott Nelson R, Kolts R, Park R, Heikenen J. dyskinesia: the most common indication AM, Bennett PH. Development of lithogenic A comparison of cholecystectomy and ob- for cholecystectomy in children. Surgery. bile during puberty in Pima indians. N Engl servation in children with biliary dyskine- 2005;138(4):726–731, discussion 731–733 J Med. 1979;300(16):873–876 sia. J Pediatr Surg. 2006;41(11):1894–1898 PEDIATRICS Volume 129, Number 1, January 2012 7 Downloaded from by guest on November 4, 2015
Clinical Characteristics and Risk Factors for Symptomatic Pediatric Gallbladder Disease Seema Mehta, Monica E. Lopez, Bruno P. Chumpitazi, Mark V. Mazziotti, Mary L. Brandt and Douglas S. Fishman Pediatrics; originally published online December 12, 2011; DOI: 10.1542/peds.2011-0579 Updated Information & including high resolution figures, can be found at: Services /content/early/2011/12/07/peds.2011-0579 Citations This article has been cited by 5 HighWire-hosted articles: /content/early/2011/12/07/peds.2011-0579#related-urls Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: /site/misc/Permissions.xhtml Reprints Information about ordering reprints can be found online: /site/misc/reprints.xhtml PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2011 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from by guest on November 4, 2015
Clinical Characteristics and Risk Factors for Symptomatic Pediatric Gallbladder Disease Seema Mehta, Monica E. Lopez, Bruno P. Chumpitazi, Mark V. Mazziotti, Mary L. Brandt and Douglas S. Fishman Pediatrics; originally published online December 12, 2011; DOI: 10.1542/peds.2011-0579 The online version of this article, along with updated information and services, is located on the World Wide Web at: /content/early/2011/12/07/peds.2011-0579 PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2011 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from by guest on November 4, 2015
You can also read