Clinical Profile and Evaluation of Outcomes of Symptomatic Gallstone Disease in the Senior Citizen Population

Abstract

BackgroundThere is a heavy burden of gallstone disease on the world's population. The incidence and severity of symptomatic cholelithiasis increase with age. There is often a delay in presentation, leading to complicated disease, diagnostic delay, and increased morbidity. There is a paucity of studies on the presentation and management of cholelithiasis in elderly persons from the western part of India. This study aimed to observe the spectrum of presentation and management of symptomatic cholelithiasis in senior citizens. ObjectivesThe primary objective of this study was to describe the presentation, diagnosis and intraoperative findings of symptomatic gallstone disease (GSD) in patients aged over 60 years. The secondary objectives of this study were to find the association of GSD with age, sex, and comorbidities, including diabetes mellitus, hypertension, and thyroid disorders. MethodsAll patients above the age of 60 years presenting to the surgical outpatient and emergency departments from January 2020 to July 2021 with symptomatic GSD were included. Details of history, physical examination, blood investigations, and imaging of the abdomen (ultrasonography and Magnetic Resonance Cholangiopancreaticography, when indicated) were recorded. Patients were managed as per the advice of the treating consultant. Details of management and outcomes, including hospital stay, mortality, and morbidity, were noted. The descriptive data were organised into tables and percentages. The significance of various data and relationships between various variables was analysed using the Pearson chi-square test, Fischer exact test and scatter plots. ResultsA total of 76 patients were evaluated in this study, of which 73.7% were female. The mean age was 70.8 ± 1.7 years. The majority of patients (63.2%) were admitted through the outpatient department (OPD). The most common presenting complaint was abdominal pain (96.1%). Clinical jaundice was noted in 9.2%. Complicated Gall Stone Disease (GSD) was found more commonly in the female population (57.1%). Complicated GSD was more commonly found in patients with diabetes (p=0.075) and hypothyroidism (p=0.057). No association of age with intraoperative complications was noted (p = 0.446). ConclusionSenior citizens can present with both complicated and uncomplicated GSD. GSD, in the presence of hypothyroidism or diabetes mellitus, presents in a much more complicated form. Early surgical intervention in form of laparoscopic cholecystectomy can be beneficial to the patient if diagnosed with symptomatic gallstones. Patients of this age group need not be over investigated if a benign pathology is suspected.

An observational study on spectrum of complications in gallstone disease in Western Maharashtra

“…The study aligns with the emphasis put by S. Mukai et al [1] on the centrality of pain in the abdomen (87.4%) in diagnosing gallstone-related conditions, highlighting the consistency and reliability of this symptom. The study is consistent with the opinion of M. Lodha et al [6], reinforcing the significance of pain in the abdomen in diagnosing gallstone-related conditions. Both studies contribute to the understanding of clinical profiles and outcomes in symptomatic gallstone disease.…”

“…Nevertheless, their study primarily focuses on general considerations, warranting a specialised investigation into the unique complications prevalent in Western Maharashtra. M. Lodha et al [6] provided insights into specific complications in gallstone disease, contributing to the overall knowledge base. Their work offers valuable perspectives on the complexities of managing particular complications.…”

A study of H. pylori infection as risk factor for the gall stone disease

“…27 Other authors also have the similar findings. [28][29] In present study out of 35 cases only one case showed presence of H. pylori. In this case gall bladder wall showed sloughing of mucosa with presence of inflammatory cell infiltrates in the lamina propria with occasional suspicious organism on H and E stain.…”