Epidemiology and treatment of gallstones in 2010

Transcription

1 Epidemiology and treatment of gallstones in 2010 Adolfo Francesco Attili Università di Roma La Sapienza Rome, october 8, 2008

2 Fasi degli studi epidemiologici 1. Trasversale (prevalenza e fattori associati) 2. Longitudinale (incidenza e fattori di rischio 3. Verifica (riduzione dell incidenza attraverso la modifica dei fattori di rischio)

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4 Origine dei dati presentati M.i.col. Studio trasversale uomini e donne rappresentativi della popolazione generale questionario (incluso frequenza di consumo alimentare di 38 alimenti), ecografia, biochimica Prevalenza e fattori associati M.i.col. Studio longitudinale 4828 uomini e 3433 donne senza calcoli all inizio Ecografia a distanza di 7 anni dalla prima indagine Incidenza e fattori di rischio

5 Prevalence and incidence of GD in Italy Age men women Prevalence (%) Incidence (%/year) 0,66 0,81

6 Prevalence of GD according to AGE Univariate analysis % Men Women AGE

7 Prevalence of GD according to BMI Univariate analysis % Men Women <= BMI

8 RR (mean and 95% CI) for GD in subjects with DIABETES Univariate analysis Men Women 1.54 ( ) 1.92 ( )

9 Incidence of GD according to diabetes Men Women 2 0 No Diabetes Diabetes

10 Odds Ratio Age Adjusted OR of Gallstone Disease and 95% CI by Number of Pregnancies 2,5 2 1,5 1 OR - 95% CI + 95% CI 0, >4 Number of Pregnancies

11 Biliary sludge and GS during pregnancy 5 4,5 4 3,5 3 2,5 2 1,5 1 0,5 0 1 Trim. 2 Trim. 3 Trim. postpartum sludge GS da Ko WC et al Hepatology 2005;41: modificato

12 Base

13 Pregnancy

14 II trimester

15 III Trimester

16 postpartum

17 da Ko WC et al Hepatology 2005;41: modificato

18 Age Adjusted OR of Gallstone Disease in women and 95% CI by Serum Cholesterol Levels

19 Dietary habits Major nutrients Alcohol Fiber Fasting

20 1,4 RR for GS according to quintiles of energy adjusted total carbohydrate intake Multivariate analysis RR 1,3 1,2 1,1 1 0,9 Chi sq. for trend = 9,39; P = * * * Chi sq. for trend = 5.95; P = I II III IV V. * = P<0,01 QUINTILES Males Females MICOL

21 RR for GS according to quintiles of energy adjusted alcohol intake Multivariate analysis * Chi sq. for trend = 10.86; P = * * * = P<0,01 MICOL

22 RR for GS and serum HDL-C according to daily WINE consumption Univariate analysis

23 Prevalence of GD according to duration of overnight fasting period Univariate analysis * * * P < 0.005

24 RR (mean and 95% CI) for GD in mothers or fathers of subjects with GD Mothers Fathers Univariate analysis 2,35 (1.38-4,3) 1.75 (0,98-2,6) Attili AF World J Gastroenterol 2005, 11:

25 Subjects at elevated risk of forming GS Obese Obese during weight reduction Women during pregnancies Fasting Diabetic Familiarity for GD

26 Measures to reduce GS formation Avoid fasting Moderate carbohydrate consumption Avoid obesity If rapid weight loss consider UDCA One glass of wine Monitor GB during pregnancy

27 Open vs Laparoscopic Cholecystectomy in symptomatic gallstone patients Mortality 1/485 0,2% Intraoperative complications Minor complications Severe complications Risk OC Risk LC Quality of evidence 1/939 0,1 % 35/939 3,7 % 72/939 7,7 % Bile duct injuries 2/939 0,2 % 0/502 0 % 9/275 0,9 % 23/975 2,4 % 25/975 2,6 % 2/975 0,2 % very low very low very low very low very low Overview of reviews. The Cochrane Collaboration 2010

28 Treatment of GS in 2010 Laparoscopic Cholecystectomy is the treatment of choice for SYMPTOMATIC and complicated GS ASYMPTOMATIC GS patients should not be operated except those with porcellain gb or gs in the bile duct

29 Possible outcomes of prophylactic Laparoscopic Cholecystectomy PLCO - or Expectant Management EM - for asymptomatic GS PLCO EM Death Complications Death Complications GB cancer

30 GD related deaths according to age and to expectant management (EM) or prophylactic Laparoscopic Cholecystectomyb (PLC)

31 No. of life years lost according to expexctant management (EM) or prophylactic cholecystectomy (PLC)

32 Cholecystectomy in Italy during (excluding Sardinia) = 138/ inhabitants % laparoscopic : 87,26 (85,96 in 2007)

33 Percent laparoscopic in different Italian regions (2009)

34 Indications for cholecysrtectomy MICOL longitudinal study

35 Grazie per la vostra attenzione Adolfo Francesco Attili