Predictors of gallstone composition in 1025 symptomatic gallstones from Northern Germany.
BACKGROUND
Gallstones represent a prevalent and costly health problem. The changing epidemiology and the emerging non-surgical interventions for gallstone disease necessitate the definition of target populations for future therapies. This study aimed to define patterns of gallstone composition and identify demographic predictors of gallstone composition in a large sample of symptomatic gallstones from Northern Germany.


METHODS
One thousand and seventy-four post-cholecystectomy gallstone specimens were obtained. Demographic and clinical information was provided by questionnaire (N = 1025 independent individuals with complete information). Two samples from each gallstone were analyzed using Fourier transformed infrared spectrometry.


RESULTS
The most prevalent substance was cholesterol, which was detected in 95.0% of gallstone specimens. Bilirubin and bilirubinate were present in 30.0% and calcium was detected in 10.0% of the spectra. Ninety-two percent of measurements from the same stone yielded the same "main" substances, indicating a homogenous stone composition in most cases. Female sex and higher body mass index (BMI) were associated with the presence of cholesterol as a main substance in the gallstones (p < 0.001).


CONCLUSIONS
The changing epidemiology of gallstone disease is reflected by a marked shift in stone composition: Only two percent of stones in this study were pigment stones as compared to 91% percent of stones containing cholesterol as a main substance. Obese individuals from Germany with a BMI > 30 kg/m2 have in 95% cholesterol-dominant gallstones and represent a potential target population for non-surgical interventions for the prevention or treatment of cholesterol stones.
Schafmayer
Clemens
C
Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 7, D-24105 Kiel, Germany. cschafmayer@chirurgie-sh.de <cschafmayer@chirurgie-sh.de>
Hartleb
Jürgen
J
Tepel
Jürgen
J
Albers
Stefan
S
Freitag
Sandra
S
Völzke
Henry
H
Buch
Stephan
S
Seeger
Markus
M
Timm
Birgit
B
Kremer
Bernd
B
Fölsch
Ulrich R
UR
Fändrich
Fred
F
Krawczak
Michael
M
Schreiber
Stefan
S
Hampe
Jochen
J
D000367:Age Factors; D001654:Bile Pigments / Q000032:analysis; D001663:Bilirubin / Q000032:analysis; D015992:Body Mass Index; D002118:Calcium / Q000032:analysis; D002763:Cholecystectomy; D002784:Cholesterol / Q000032:analysis; D005260:Female; D042882:Gallstones / Q000737:chemistry* / Q000145:classification / Q000453:epidemiology / Q000473:pathology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D017678:Sex Distribution; D012737:Sex Factors; D017550:Spectroscopy, Fourier Transform Infrared
D001654:Bile Pigments; D002784:Cholesterol; D001663:Bilirubin; D002118:Calcium