Current Gastroenterology Reports

, Volume 7, Issue 2, pp 132–140 | Cite as

Epidemiology and risk factors for gallstone disease: Has the paradigm changed in the 21st century?

  • Eldon A. Shaffer


Gallstone disease is common and costly, creating over 700,000 cholecystectomies annually. Its complications consume approximately $6.5 billion in the United States. Surveys using noninvasive ultrasonography have identified its true prevalence and the associated risk factors. In developed countries, at least 10% of white adults harbor cholesterol gallstones; women have twice the risk, and age further increases the prevalence in both sexes. Gallstones reach epidemic proportions in the North and South American Indian populations, accompanied by an increased risk for gallbladder cancer. In contrast, the rate in sub-Saharan Africa and Asia is quite low. Obesity, a major risk factor, likely relates to insulin resistance (the metabolic syndrome). Evolution and circumstance in American Indians may have ironically selected those with "thrifty" genes that conserve energy. Our abundant access to food places us at the increased risk of obesity and cholelithiasis. The general rise in obesity in many countries raises the specter of heightened disease, best identified by epidemiologic studies.


Cholelithiasis Gallbladder Cancer Gallstone Disease Gallbladder Disease Gallstone Formation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Russo MW, Wei JT, Thiny MT, et al.: Digestive and liver diseases statistics, 2004. Gastroenterology 2004, 126:1448–1453. This paper has collected the recent incidence, prevalence, mortality, and resource utilization of digestive and liver diseases in the United States from large publicly available national data bases (Division of Vital Statistics, National Center for Health Statistics, National Ambulatory Medical Care Survey 2000, and National Inpatient Sample), yielding impressively large numbers that add to its validity. Such valuable information provides an important resource for authors, granting agencies, funding agencies, and policy makers. The burden of disease is clearly illustrated in tables and in the comments within the text.PubMedCrossRefGoogle Scholar
  2. 2.
    Plant JC, Percy I, Bates T, et al.: Incidence of gallbladder disease in Canada, England, and France. Lancet 1973, 2:249–251.PubMedCrossRefGoogle Scholar
  3. 3.
    Bateson MC: Gallstones and cholecystectomy in modern Britain. Postgrad Med J 2000, 76:700–703.PubMedCrossRefGoogle Scholar
  4. 4.
    Legorreta AP, Silber JH, Costantino GN, et al.: Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy. JAMA 1993, 270:1429–1432.PubMedCrossRefGoogle Scholar
  5. 5.
    Kang J-Y, Ellis C, Majeed A, et al.: Gallstones—an increasing problem: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther 2003, 17:561–569. Over the 10-year period studied from statistics collected by the National Health Service in England (excluding private patients), there was an increased admission for cholelithiasis. The frequency of cholecystectomy actually declined with an increase in therapeutic endoscopic procedures.PubMedCrossRefGoogle Scholar
  6. 6.
    American Gastroenterological Association: The Burden of Gastrointestinal Diseases. Bethesda, MD: The American Gastroenterological Association; 2001.Google Scholar
  7. 7.
    Everhart JE, Khare M, Hill M, Maurer KR: Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 1999, 117:632–639. This landmark paper was the first large US population-based estimate of the prevalence of gallstones and gallbladder disease. It included 14,000 participants who underwent screening ultrasonography, as part of the Third National Health and Nutrition Examination Survey (NHANES III).PubMedCrossRefGoogle Scholar
  8. 8.
    Aerts R, Penninckz F: The burden of gallstone disease in Europe. Aliment Pharamacol Ther 2003, 18 (Suppl.3):49–53. Fine review of prevalence surveys in Europe.CrossRefGoogle Scholar
  9. 9.
    Gracie WA, Ransohoff DF: The natural history of silent gallstones. N Engl J Med 1982, 307:798–800.PubMedCrossRefGoogle Scholar
  10. 10.
    Sampliner RE, Bennett PH, Comess LJ, et al.: Gallbladder disease in Pima Indians: demonstration of high prevalence and early onset by cholecystography. N Engl J Med 1970, 283:1358–1364.PubMedCrossRefGoogle Scholar
  11. 11.
    Thistle JL, Eckhart KL, Nensel RE, et al.: Prevalence of gallbladder disease among Chippewa Indians. Mayo Clin Proc 1971, 46:603–608.PubMedGoogle Scholar
  12. 12.
    Williams CN, Johnston JL, Weldon KLM: Prevalence of gallbladder and gallstone disease in Canadian Micmac Indians. Can Med Assoc J 1977, 117:758–760.PubMedGoogle Scholar
  13. 13.
    Everhart JE, Yeh F, Lee ET, et al.: Prevalence of gallbladder disease in American Indian populations: findings from the Strong Heart study. Hepatology 2002, 35:1507–1512. American Indians have the highest prevalence of gallstones in the world: approximately 50% of men and 80% of women. This rather large ultrasound study involved 3296 middle-aged (47 years+) American Indians whose racial origin was based on their grandparents’ heritage; 64.1% of the women and 29.5% of the men had gallbladder disease (as gallstones or previous cholecystectomy). The epidemic proportions were no different across 13 tribes in three different states.PubMedCrossRefGoogle Scholar
  14. 14.
    Miquel JF, Covarrubias C, Villaroel L, et al.: Genetic epidemiology of cholesterol cholelithiasis amongst Chilean Hispanic, Amerindians, and Maoris. Gastroenterology 1998, 115:937–946.PubMedCrossRefGoogle Scholar
  15. 15.
    Nervi F, Miquel JF, Marshall G. The Amerindian epidemics of cholesterol gallstones: the North and South connection [letter]. Hepatology 2003, 37:947–948.PubMedCrossRefGoogle Scholar
  16. 16.
    Attili AF, Carulli N, Roda E, et al.: Epidemiology of gallstone disease in Italy: prevalence data of the Multicenter Italian study on Cholelithiasis (MICOL). Am J Epidemiol 1995, 141:158–165.PubMedGoogle Scholar
  17. 17.
    Barbara L, Sama C, Morselli-Labate AM, et al.: A population study on the prevalence of gallstone disease: the Sirmione study. Hepatology 1987, 7:913–919.PubMedCrossRefGoogle Scholar
  18. 18.
    Shoda J, Tanaka N, Osuga T: Hepatolithiasis: epidemiology and pathogenesis update. Front Biosci 2003, 8:e398-e409. An excellent review.PubMedCrossRefGoogle Scholar
  19. 19.
    Garimaldi CH, Nelson RG, Pettitt DJ, et al.: Increased mortality with gallstone disease: results of a twenty year population base survey in Pima Indians. Ann Intern Med 1993, 118:185–190.Google Scholar
  20. 20.
    Mitchell BD, Williams Blangero S, Chakraborty R, et al.: A comparison of three methods for assessing Amerindian admixture in Mexican Americans. Ethn Dis 1993, 3:22–31.PubMedGoogle Scholar
  21. 21.
    Serra I, Calvo A, Baez S et al.: Risk factors for gallbladder cancer: an international collaborative case-control study. Cancer 1996, 78:1515–1516.PubMedCrossRefGoogle Scholar
  22. 22.
    Pandey M: Risk factors for gallbladder cancer: a reappraisal. Eur J Cancer Prevent 2003, 12:15–24. Up-to-date review.CrossRefGoogle Scholar
  23. 23.
    Kelly TR, Chamberlain TR: Carcinoma of the gallbladder. Am J Surg 1982, 143:737–741.PubMedCrossRefGoogle Scholar
  24. 24.
    Carey MC, Paigen B: Epidemiology of the American Indians’ burden and its likely genetic origins. Hepatology 2002, 36:781–791.PubMedGoogle Scholar
  25. 25.
    van der Linden W: Genetics of cholelithiasis. In Genetics and Heterogeneity of Common Gastrointestinal Disorders. Edited by Rotter JT, Samloff IM, Rimion DL. New York: Academic Press; 1980:313–320.Google Scholar
  26. 26.
    Sarin SK, Negi VS, Dewan R, et al.: High familial prevalence of gallstones in the first degree relatives of gallstone patients. Hepatology 1995, 22:138–141.PubMedGoogle Scholar
  27. 27.
    Shaffer EA: Cholestasis: the ABCs of cellular mechanisms for impaired bile secretion: transporters and genes. Can J Gastroenterol 2002, 16:380–389.PubMedGoogle Scholar
  28. 28.
    Rosmorduc O, Hermelin B, Boelle P-Y, et al.: ABCB4 gene mutation-associated cholelithiasis in adults. Gastroenterology 2003, 125:452–459.PubMedCrossRefGoogle Scholar
  29. 29.
    Lowenfels AB: Gallstones in glaciers: the stone that came in from the cold. Lancet 1988, 1:1385–1386.PubMedCrossRefGoogle Scholar
  30. 30.
    Chen CY, Lu CL, Huang YS, et al.: Age is one of the risk factors in developing gallstone disease in Taiwan. Age Aging 1998, 27:437–441.CrossRefGoogle Scholar
  31. 31.
    Barbara L, Sama C, Morselli-Labate AM, et al.: A population study on the prevalence of gallstone disease: the Sirmone study. Hepatology 1987, 7:913–919.PubMedCrossRefGoogle Scholar
  32. 32.
    The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO): The epidemiology of gallstone disease in Rome, Italy. Part I. Prevalence data in men. Hepatology 1988, 8:904–906.CrossRefGoogle Scholar
  33. 33.
    Attili F, Capocaccia L. Carulli N, et al.: Factors associated with gallstone disease in the MICOL experience. Hepatology 1997, 26:809–818.PubMedCrossRefGoogle Scholar
  34. 34.
    Marinhini A, Ciambra M, Baccelliere P, et al.: Biliary sludge and gallstones in pregnancy: incidence, risk factors, and natural history. Ann Intern Med 1993, 119:116–120.Google Scholar
  35. 35.
    Valdivieso V, Covarrubias C, Siegel F, Cruz F: Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early pregnancy. Hepatology 1993, 17:1–4.PubMedGoogle Scholar
  36. 36.
    Thijs C, Knipschild P: Oral contraceptives and the risk of gallbladder disease: a meta-analysis. Am J Public Health 1993, 83:1113–1120.PubMedCrossRefGoogle Scholar
  37. 37.
    Hulley S, Grady D, Bush T, et al., for the Heart and Estrogen/progestin Replacement Study (HERS). Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998, 280:605–613.PubMedCrossRefGoogle Scholar
  38. 38.
    Friedman GD, Kamel WB, Dawber TR: The epidemiology of gallbladder disease: observations in the Framingham study. J Chronic Dis 1996, 19:273–292.CrossRefGoogle Scholar
  39. 39.
    Shaffer EA, Small DM: Biliary lipid secretion in cholesterol gallstone disease: the effect of cholecystectomy and obesity. J Clin Invest 1977, 59:828–840.PubMedCrossRefGoogle Scholar
  40. 40.
    AGA technical review on obesity. Gastroenterology 2002, 123:882–932. An excellent, authoritative review.Google Scholar
  41. 41.
    Flegal KM, Carroll MD, Odgen CL, et al.: Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2000, 288:1723–1727.CrossRefGoogle Scholar
  42. 42.
    Stein CJ, Colditz GA: The epidemic of obesity. J Clin Endocrinol Metab 2004, 89:2522–2325.PubMedCrossRefGoogle Scholar
  43. 43.
    Stampfer MJ, Maclure KM, Colditz GA, et al.: Risk of gallstones in women. Am J Clin Nutr 1992, 55:652–658.PubMedGoogle Scholar
  44. 44.
    Liddle RA, Goldstein RB, Saxton J: Gallstone formation during weight-reduction dieting. Arch Intern Med 1989, 149:1750–1753.PubMedCrossRefGoogle Scholar
  45. 45.
    Shiffman ML, Sugerman HJ, Kellum JM, et al.: Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol 1991, 86:1000–1005.PubMedGoogle Scholar
  46. 46.
    Al-Jiffry BO, Shaffer EA, Saccone GTP, et al.: Changes in gallbladder motility and gallstone formation following laparoscopic gastric banding for morbid obesity Can J Gastroenterol 2003, 17:169–174.PubMedGoogle Scholar
  47. 47.
    Syngal C, Coakley EH, Willett WC, et al.: Long-term weight patterns and risk for cholecystectomy in women. Ann Intern Med 1999, 130:471–477.PubMedGoogle Scholar
  48. 48.
    Jorgensen T, Jorgensen LM: Gallstones and diet in a Danish population. Scand J Gastroenterol 1989, 24:821–826.PubMedGoogle Scholar
  49. 49.
    Kameda H, Ishihara F, Shibata K, et al.: Clinical and nutritional study on gallstone disease in Japan. Jpn Med J 1984, 23:109–113.Google Scholar
  50. 50.
    Acalovschi M: Cholesterol gallstones: from epidemiology to prevention. Postgrad Med 2001, 77:221–229.CrossRefGoogle Scholar
  51. 51.
    Tsai C-J, Leitzmann MF, Willett WC, et al.: The effect of longterm intake of cis unsaturated fats on the risk for gallstone disease in men. Ann Intern Med 2004, 141:514–522. This prospective cohort study identified that long-term intake of cis unsaturated fats appears to reduce the risk of gallstone disease in men.PubMedGoogle Scholar
  52. 52.
    Leitzmann MF, Rimm EB, Willett WC, et al.: Recreational physical activity and the risk of cholecystectomy in women. N Engl J Med 1999, 341:777–784.PubMedCrossRefGoogle Scholar
  53. 53.
    Leitzmann MF, Giovannucci EL, Rimm EB, et al.: The relation of physical activity to risk for symptomatic gallstone disease in men. Ann Intern Med 1998, 128:417–425.PubMedGoogle Scholar
  54. 54.
    De Santis A, Attili AF, Ginanni Corradini S, et al.: Gallstones and diabetes: a case-control study in a free-living population sample. Hepatology 1997, 25:787–790.PubMedCrossRefGoogle Scholar
  55. 55.
    Pagliarulo M, Fornari F, Fraquelli M, et al.: Gallstone disease and related risk factors in a large cohort of diabetic patients. Digest Liver Dis 2004, 36:130–134.CrossRefGoogle Scholar
  56. 56.
    Diehl AK: Cholelithiasis and the insulin resistance syndrome. Hepatology 2000, 31:528–530.PubMedCrossRefGoogle Scholar
  57. 57.
    Grundy SM: Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab 2004, 89:2595–2600.PubMedCrossRefGoogle Scholar
  58. 58.
    Shaffer EA: NASH: Non-alcoholic steatohepatitis. Can J Gastroenterol 2002, 16:318–321.PubMedGoogle Scholar
  59. 59.
    Klein SK, Fontana L, Young VL, et al.: Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med 2004, 350:2549–2557.PubMedCrossRefGoogle Scholar
  60. 60.
    St-Onge M-P, Janssen IJ, Heymsfield SB: Metabolic syndrome in normal-weight Americans. Diabetes Care 2004, 27:2222–2228.PubMedCrossRefGoogle Scholar
  61. 61.
    Seidell JC: Obesity, insulin resistance and diabetes: a world wide epidemic. Br J Nutr 2000, 83(Suppl 1):55–58.Google Scholar
  62. 62.
    Thijs C, Knipschild P, Brombacher P: Serum lipids and gallstones: a case-control study. Gastroenterology 1990, 99:843–849.PubMedGoogle Scholar
  63. 63.
    Petitti DB, Friedman GD, Klatsky AL: Association of a history of gallbladder disease with a reduced concentration of highdensity-lipoprotein cholesterol. N Engl J Med 1981, 304:1396–1398.PubMedCrossRefGoogle Scholar
  64. 64.
    The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO): The epidemiology of gallstone disease in Rome, Italy. Part II. Factors associated with the disease. Hepatology 1988, 8:907–913.CrossRefGoogle Scholar
  65. 65.
    Conte D, Fraquelli M, Fornari F et al.: Close relation between cirrhosis and gallstones: Cross-sectional and longitudinal survey. Arch Intern Med 1999, 159:49–52.PubMedCrossRefGoogle Scholar
  66. 66.
    Lapidus, Bangstad M, Astrom M, Muhrbeck O: The prevalence of gallstone disease in a defined cohort of patients with Crohn’s disease. Am J Gastroenterol 1999, 94:1261–1266.PubMedCrossRefGoogle Scholar
  67. 67.
    Rutgeerts P, Ghoos Y, Vantrappen G, Fevery J: Biliary lipid composition in patients with nonoperated Crohn’s disease. Dig Dis Sci 1986, 31:27–32.PubMedCrossRefGoogle Scholar
  68. 68.
    Brink MA, Slors JF, Yolande CA, et al.: Enterohepatic cycling of bilirubin: a putative mechanism for pigment gallstone formation in ileal Crohn’s disease. Gastroenterology 1999, 116:1430–1437.CrossRefGoogle Scholar
  69. 69.
    Roslyn JJ, Pitt HA, Mann LL, et al.: Gallbladder disease in patients on long-term parenteral nutrition. Gastroenterology 1983, 84:148–154.PubMedGoogle Scholar
  70. 70.
    Apstein M D, Dalecki-Chipperfield K: Spinal cord injury is a risk factor for gallstone disease. Gastroenterology 1987, 92:966–968.PubMedGoogle Scholar
  71. 71.
    Bigg-Wither GW, Ho KK, Grunstein RR, et al.: Effects of longterm octreotide on gallstone formation and gallbladder function. BMJ 1992, 304:1611–1612.PubMedGoogle Scholar
  72. 72.
    Lopez AJ, O’Keefe P, Morrissey M, Pickleman J: Ceftriaxoneinduced cholelithiasis. Ann Intern Med 1991, 115:712–714.PubMedGoogle Scholar
  73. 73.
    Kratzer W, Mason RA, Kachele V: Prevalence of gallstones in sonographic surveys worldwide. J Clin Ultrasound 1998, 27:1–7.CrossRefGoogle Scholar
  74. 74.
    Ratner J, Lisbona A, Rosenbloom M, et al.: The prevalence of gallstone disease in very old institutionalized persons. JAMA 1991, 265:902–903.PubMedCrossRefGoogle Scholar
  75. 75.
    Maurer KR, Everhart JE, Ezzati TM, et al.: Prevalence of gallstone disease in Hispanic populations in the United States. Gastroenterology 1989, 96:487–492.PubMedGoogle Scholar
  76. 76.
    Hanis CL, Hewett-Emmett D, Kubrusly LF, et al.: An ultrasound survey of gallbladder disease among Mexican Americans in Starr County, Texas: frequency and risk factors. Ethn Dis 1993, 3:32–43.PubMedGoogle Scholar
  77. 77.
    Covarrubias C, Miquel J, Puglielli L, et al.: The role of ethnicity and other risk factors for cholelithiasis in a highly prevalent area: cross-sectional and cohort studied in Chileans and Amerindian Araucanos [abstract]. Gastroenterology 1995, 108:A1053.Google Scholar
  78. 78.
    Moro PL, Checkley W, Gilman RH, et al.: Gallstone disease in Peruvian coastal natives and highland natives. Gut 2000, 46:569–573.PubMedCrossRefGoogle Scholar
  79. 79.
    Attili AF, Carulli N, Roda E, et al.: Epidemiology of gallstone disease in Italy: prevalence data of the multicenter Italian study on cholelithiasis (MICOL). Am J Epidemiol 1995, 141:158–165.PubMedGoogle Scholar
  80. 80.
    Angelico F, Del Ben M, Barbato A, Conti R, Urbinati G: Ten-year incidence and natural history of gallstone disease in a rural population of women in central Italy. The Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). Ital J Gastroenterol Hepatol 1997, 29:249–254.PubMedGoogle Scholar
  81. 81.
    Loria P, Dilengite MA, Bozzoli M, et al.: Prevalence rates of gallstone disease in Italy: the Chianciano population study. Eur J Epidemiol 1994, 10:143–150.PubMedCrossRefGoogle Scholar
  82. 82.
    Misciagna G, Leoci C, Elba S, et al.: The epidemiology of cholelithiasis in southern Italy. Eur J Gastroenterol Hepatol 1994, 6:937–941.CrossRefGoogle Scholar
  83. 83.
    Palasciano G, Portincasa P, Vinciguerra V, et al.: Gallstone prevalence and gallbladder volume in children and adolescents: an epidemiological ultrasonographic survey and relationship to body mass index. Am J Gastroenterol 1989, 84:1378–1382.PubMedGoogle Scholar
  84. 84.
    Montalto G, Soresi M, Carroccio A, et al.: Prevalence of biliary lithiasis in the elderly people of a small town in Sicily. Age Ageing 1992, 21:338–342.PubMedCrossRefGoogle Scholar
  85. 85.
    Lirussi F, Nassuato G, Passera D, et al.: Gallstone disease in an elderly population: the Silea study. Eur J Gastroenterol Hepatol 1999, 11:473–475.CrossRefGoogle Scholar
  86. 86.
    Okolicsanyi L, Passera D, Nassuato G, et al.: Epidemiology of gallstone disease in an older Italian population in Montegrotto Terme, Padua. Am Geriatr Soc 1995, 43:902–905.Google Scholar
  87. 87.
    Progetto Distretto Sezze Controllo Comunitario (DISCO), Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO): Epidemiology of gallstone disease in Italy: comparison between a rural and urban female population. Ital J Gastroenterol 1987, 19:129–133.Google Scholar
  88. 88.
    Janzon L, Aspelin P, Eriksson S, et al.: Ultrasonographic screaming for gallstone disease in middle-aged women. Detection rate, symptoms, and biochemical features. Scand J Gastroenterol 1985, 20:706–710.PubMedGoogle Scholar
  89. 89.
    Mellstrom D, Asztely M, Svanvik J: Gallstones and previous cholecystectomy in 77- to 78-year-old women in an urban population in Sweden. Scand J Gastroenterol 1988, 23:1241–1244.PubMedGoogle Scholar
  90. 90.
    Muhrbeck O, Ahlberg J: Prevalence of gallstone disease in a Swedish population. Scand J Gastroenterol 1995, 30:1125–1128.PubMedGoogle Scholar
  91. 91.
    Jorgensen T: Prevalence of gallstones in a Danish population. Am J Epidemiol 1987, 126:912–921.PubMedGoogle Scholar
  92. 92.
    Jorgensen T, Kay L, Schultz-Larsen K: The epidemiology of gallstones in a 70-year-old Danish population. Scand J Gastroenterol 1990, 25:335–340.PubMedGoogle Scholar
  93. 93.
    Glambek I, Kvaale G, Arnesjo B, Soreide O: Prevalence of gallstones in a Norwegian population. Scand J Gastroenterol 1987, 22:1089–1094.PubMedGoogle Scholar
  94. 94.
    Heaton KW, Braddon FE, Mountford RA: Symptomatic and silent gall stones in the community. Gut 1991, 32:316–320.PubMedGoogle Scholar
  95. 95.
    Pixley F, Wilson D, McPherson K, Mann J: Effect of vegetarianism on development of gall stones in women. BMJ (Clin Res Ed) 1985, 291:11–12.Google Scholar
  96. 96.
    Rhomberg HP, Judmair G, Lochs A: How common are gallstones? [letter] BMJ (Clin Res Ed) 1984, 13:1002.Google Scholar
  97. 97.
    Berndt H, Nurnberg D, Pannwitz H: Prevalence of cholelithiasis: results of an epidemiologic study using sonography in East Germany. Z Gastroenterol 1989, 27:662–666.PubMedGoogle Scholar
  98. 98.
    Marliecz K, Mandat A, Starzynska T, et al.: Prevalence of gallstones in a female Polish population [abstract]. Gastroenterol Int 1988, 1:A134.Google Scholar
  99. 99.
    Sporea A, Goldis A, Mateoc A: Echogenic screening concerning the incidence of gallstones in a general population [abstract]. Gastroenterology 1993, 104:A379.Google Scholar
  100. 100.
    Caroli-Bosc, Hastier P, Delabre B, et al.: Prevalence and risk factors of gallstone disease in a town of South France (Vidauban) [abstract]. Gastroenterology 1996, 110:A9.Google Scholar
  101. 101.
    Khuroo MS, Mahajan R, Zargar SA, et al.: Prevalence of biliary tract disease in India: a sonographic study in adult population in Kashmir. Gut 1989, 30:201–205.PubMedGoogle Scholar
  102. 102.
    Nomura H, Kashiwagi S, Hayashi J, et al.: Prevalence of gallstone disease in a general population of Okinawa, Japan. Am J Epidemiol 1988,128:598–605.PubMedGoogle Scholar
  103. 103.
    Prathnadi P, Miki M, Suprasert S: Incidence of cholelithiasis in the northern part of Thailand. J Med Assoc Thai 1992, 75:462–70.PubMedGoogle Scholar
  104. 104.
    Lu SN, Chang WY, Wang LY: Risk factors for gallstones among Chinese in Taiwan: a community sonographic survey. J Clin Gastroenterol 1990, 12:542–6.PubMedCrossRefGoogle Scholar
  105. 105.
    Zhao Y, Zhang R, Hu Y, et al.: An epidemiological survey of gallstones with gray-scale ultrasound. Hua Xi Yi Ke Da Xue Xue Bao (Journal of the West China University of Medical Sciences) 1990, 21:217–220.PubMedGoogle Scholar
  106. 106.
    Singh V, Trikha B, Nain, C, et al.: Epidemiology of gallstone disease in Chandigarh: a community-based study. J Gastroenterol Hepatology 2001, 16:560–563.CrossRefGoogle Scholar
  107. 107.
    Walker AR, Segal I, Posner R, et al.: Prevalence of gallstones in elderly black women in Soweto, Johannesburg, as assessed by ultrasound. Am J Gastroenterol 1989, 84:1383–1385.PubMedGoogle Scholar
  108. 108.
    Bagi Abdel M, Arabi M, Abdel Rahim B, et al.: Prevalence of gallbladder disease in Sudan: first sonographic field study in adult population [abstract]. Gastroenterology 1991, 100:A307.Google Scholar
  109. 109.
    Pedersen G, Hoem D, Andren-Sandberg A: Influence of laparoscopic cholecystectomy on the prevalence of operations for gallstones in Norway. Eur J Surg 2002, 168:464–469.PubMedCrossRefGoogle Scholar
  110. 110.
    Zacks SL, Sandler RS, Rutledge R, Brown RS: A populationbased cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol 2002, 97:334–340.PubMedCrossRefGoogle Scholar

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© Current Science Inc 2005

Authors and Affiliations

  • Eldon A. Shaffer
    • 1
  1. 1.Faculty of Medicine, GI DivisionUniversity of CalgaryCalgaryCanada

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