Epidemiology

Severe gallstone disease on the rise in Taiwan

Last Updated: 2009-09-07 10:00:11 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Rates of hospitalization for severe gallstone disease have risen sharply in recent years among young adults in Taiwan. Older adults have experienced increases in biliary pancreatitis and acute cholangitis.

"Clinically, the incidence of gallstone disease has been increasing in the past decade coincident with the rise in calorie and fat consumption, decrease in fiber intake, and increased prevalence of the sedentary lifestyle in the Asian population," Dr. Po-Huang Lee, of I-Sho University, Taiwan, and colleagues write in the current issue of BMC Gastroenterology. "However, estimates of the population-based incidence of symptomatic gallstone disease and related complications are lacking."

The researchers conducted a retrospective longitudinal study using the Taiwan National Health Insurance Research Database to assess nationwide trends between 1997 and 2005 in the incidence of severe gallstone disease among adults age 20 and older.

Of 170,781 patients with incident hospital admissions for severe gallstone disease, 155,322 cases were included in the study after excluding patients with cancer; HIV/AIDS (n = 9); and incomplete information.

The incidence of severe gallstone disease and acute cholecystitis was fairly stable in women. Men, however, had a significantly increased incidence of severe gallstone disease and all related complications, including a 91% increase in the incidence of acute cholangitis, compared to a 32% increase for women (p < 0.001). Men and women had similar increases in the incidence of biliary pancreatitis.

Among younger subjects (20 to 39 years), the increase in the incidence of all gallstone-related complications was significant (p < 0.001). Among those older than 60, the change in acute cholecystitis was small, but the increase in acute cholangitis and biliary pancreatitis was significant, especially among those 80 and older (p < 0.001).

The rates of elective cholecystectomy were significantly higher in women than in men. Hospital admission rates for elective cholecystectomy increased steadily among both sexes from 1997 to 2001, then decreased gradually. The most marked decline was seen in subjects aged 60 and older.

The increase in hospital admissions for elective cholecystectomy was steady among subjects 20 to 39 years old from 1997 to 2001. Thereafter, the rate began to plateau. A continuing increasing rate of non-elective cholecystectomy was observed in this population, with a significant upward trend in hospital admissions for gallstone treated by endoscopic retrograde cholangiopancreatography in both men and women (p < 0.001).

"The present study findings, in general, support our clinical observation that the rate of hospital admission for severe gallstone disease has been increasing in Taiwan during the past decade," the researchers maintain. "It seems to be related in part to the increased accessibility of the patients to hospitals after changing the insurance system in the country, although a modest increase in incidence of gallstone diseases in 10-year intervals might also play a role."

BMC Gastroenterol 2009;9:63.