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ED ulIrasound helplul buI noI deliniIive in diagnosing gallsIones

By ReuIers HeaIIh
ApríI 8, 2011


A posíIíve uIIrasound (US) exam ín Ihe emergency deparImenI (LD) can'I "ín íIseII make
Ihe díagnosís oI choIeIíIhíasís," Ihey say ín Iheír reporI. And negaIíve resuIIs don'I ruIe íI ouI íI
Ihe preIesI probabíIíIy ís hígh. BuI íI cIínícaI suspícíon Ior bíIíary coIíc ís Iow and gaIIsIones
don'I show up on US, Ihen aIIernaIíve díagnoses shouId be consídered, accordíng Io Dr.
MarshaII Ross aI Ihe UníversíIy oI CaIgary ín AIberIa, Canada, and coIIeagues. Lmergency room
docIors oIIen do US exams Io Iook Ior abdomínaI aorIíc aneurysms or perícardíaI eIIusíons, and
"sIrong evídence" shows Ihey're quíIe accuraIe aI íI, Ihe auIhors noIe ín Ihe March íssue
oI Academíc Lmergency Medícíne. BuI how weII emergency physícíans do wíIh US Ior gaIIsIones
has noI been cIear, Ihe auIhors say. In parIícuIar, research has shown IhaI IaIse negaIíves ín Ihe
LD are mosI oIIen due Io sIones IhaI are Iess Ihan 4 mm ín díameIer or ímpacIed ín Ihe
gaIIbIadder neck.
To assess Ihe díagnosIíc accuracy oI emergency deparImenI US, Ihe research Ieam
searched MLDLINL, LMBASL, Ihe Cochrane Iíbrary, and oIher sources Ior orígínaI research on
prospecIíveIy coIIecIed daIa.They requíred IhaI sIudíes have an accepIabIe reIerence sIandard
(e.g., ímagíng sIudíes ínIerpreIed by radíoIogísIs, or surgícaI Iíndíngs).AIIer revíewíng 917
arIícIes wíIh reIevanI IíIIes, Ihey ídenIíIíed eíghI sIudíes Ior Iheír IínaI anaIysís, ínvoIvíng 710
paIíenIs aIIogeIher. In each sIudy, Ihe emergency physícíans who perIormed and ínIerpreIed
Ihe US exams were unaware oI whaI radíoIogísIs díagnosed.
The number oI paIíenIs per sIudy ranged Irom 3S Io 127, and Ihe prevaIence oI
gaIIsIones ranged Irom 46º Io 80º (medían 60º). The pooIed esIímaIes Ior sensíIívíIy and
specíIícíIy were 89.8º and 88.0º, respecIíveIy. The esIímaIed posíIíve IíkeIíhood raIío was 7.S
and Ihe negaIíve IíkeIíhood raIío was 0.12. OperaIors had a wíde range oI experíence, and some
were "admíIIedIy naïve," Ihe ínvesIígaIors poínI ouI.
BuI a summary receíver operaIor curve, consIrucIed wíIh a regressíon modeI based on
unweíghIed IeasI squares esIímaIíon, showed "no ímpIícíI varíaIíon ín sensíIívíIy and specíIícíIy
across sIudíes due Io operaIor·dependenI díIIerences ín whaI deIíned a posíIíve or negaIíve IesI
resuII," Ihey say.
Dr. Ross and hís coIIeagues suggesI IhaI emergency physícíans can make a provísíonaI
díagnosís oI acuIe sympIomaIíc choIeIíIhíasís when Iheír US exams show gaIIsIones ín
assocíaIíon wíIh ríghI upper quadranI paín, epígasIríc paín, or IIank paín. II sympIoms resoIve,
appropríaIe IoIIow·up aIIer díscharge shouId be arranged, Ihey say.
The research Ieam noIes IhaI Ihe smaII síze and number oI sIudíes prevenIed any meaníngIuI
subgroup anaIysís (íncIudíng resuIIs based on operaIor experíence). Those IacIors aIso
prevenIed any deIermínaIíon oI wheIher LD physícíans couId accuraIeIy deIecI secondary sígns
oI choIecysIíIís ·· such as períchoIecysIíc IIuíd, a Ihíckened gaIIbIadder waII, or a sonographíc
"Murphy's sígn" (í.e., poínI Ienderness beneaIh Ihe probe upon pressure above Ihe gaIIbIadder).
The auIhors warn oI a poIenIíaI Ior seIecIíon bías, sínce aII eíghI sIudíes used conveníence
sampIíng. They aIso say none oI Ihe sIudíes adequaIeIy descríbed scanníng Iechníques.

hIIp:,,www.aunImínníe.com,índex.asp7sec=ser&sub=deI&pag=dís&IIemID=94906
aIIsIones Tíed Io LarIíer DeaIh

Wednesday, March 2, 2011 7:37 AM

PeopIe who have gaIIsIones are more IíkeIy Io díe wíIhín 20 years oI díagnosís
Ihan peopIe wíIhouI Ihe dísease, a new sIudy says.

aIIsIones suIIerers are aIso more IíkeIy Io díe Irom hearI dísease or cancer, saíd
Ihe sIudy, pubIíshed ín Ihe journaI asIroenIeroIogy.

The Iíndíngs don'I mean IhaI one condíIíon causes Ihe oIher. InsIead, gaIIsIone
dísease and hearI dísease may have Ihe same rooI cause, Dr. PhíIíp Baríe, proIessor oI surgery
and pubIíc heaIIh aI WeíII CorneII MedícaI CoIIege ín New York, IoId ReuIers HeaIIh.

"PeopIe wíIh gaIIsIones may have an abnormaI baIance oI IaIs ín Iheír body,
íncIudíng choIesIeroI, aIIhough Ihere's no cIear reIaIíonshíp beIween gaIIsIone dísease per se
and hígh choIesIeroI," saíd Baríe, who was noI ínvoIved ín Ihe sIudy.

More Ihan 2S míIIíon peopIe ín Ihe UníIed SIaIes have gaIIsIone dísease, and aImosI
a míIIíon new cases are díagnosed every year, accordíng Io Ihe Amerícan asIroenIeroIogícaI
AssocíaIíon.

aIIsIones happen when maIeríaI ín Ihe bíIe hardens and sIícks ín Ihe ducIs Ieadíng
Irom Ihe gaII bIadder, where bíIe ís sIored, Io Ihe smaII ínIesIíne. Because bíIe can sIíII geI Irom
Ihe Iíver, where íI ís made, Io where íI needs Io go, Ihe gaIIbIadder ísn'I necessary and can be
removed.

The researchers Iooked aI Ihe medícaI records oI more Ihan 14,000 peopIe beIween
20 and 74 years oId. AbouI one ín 14 had gaIIsIones, and one ín 20 had Iheír gaIIbIadders
removed beIween 1988 and 1994.

AbouI one ín Ihree peopIe who had gaIIsIones or Iheír gaIIbIadders removed díed
Irom any cause duríng Ihe IoIIow·up Iíme, compared Io abouI one ín seven símíIarIy aged
peopIe wíIhouI Ihe dísease.

HearI dísease cIaímed Ihe Iíves oI sIíghIIy Iess Ihan one ín Iíve gaIIsIone suIIerers,
compared Io one ín 20 peopIe wíIhouI. DeaIh Irom cancer was aIso more IíkeIy, wíIh one ín 10
peopIe wíIh gaIIsIones IaIIíng vícIím, compared Io one ín 2S peopIe wíIhouI Ihe dísease.

The researchers IoIIowed aII paIíenIs unIíI 2006, and recorded aII causes oI deaIh
Irom Ihe paIíenIs' deaIh cerIíIícaIes.

One oI Ihe auIhors on Ihe paper, Irom SocíaI and ScíenIíIíc SysIems Inc., díd noI
respond Io an ínquíry Irom ReuIers HeaIIh by deadIíne, and Ihe oIher, aI Ihe NaIíonaI InsIíIuIes
oI HeaIIh, decIíned Io commenI.

Severe gaIIsIones are usuaIIy IreaIed by cuIIíng ouI Ihe gaIIbIadder, saíd Baríe, who
does such operaIíons. The rísk oI dyíng Irom an emergency gaIIbIadder surgery ís abouI one ín
S0, dependíng on Ihe age oI Ihe paIíenI. BuI íI Ihe gaIIbIadder ís removed beIore íI becomes an
emergency, Ihe rísk oI dyíng ís onIy abouI one ín S00, he saíd.

Baríe suggesIs IhaI peopIe wíIh gaIIsIones keep on a Iow·IaI díeI Io reduce Ihe rísks oI
hearI dísease or sIroke.

"|usI a good heaIIhy díeI," he saíd.

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SIudy Línks Hígh·Carb DíeI WíIh
aIIsIones Duríng Pregnancy
DíeI Hígh ín Some Sugars May Add Io PreexísIíng Rísk Ior
aIIsIones ín PregnanI Women
by ChrísIína Irangou
Chícago-PregnanI women who consume Iarge quanIíIíes oI reIíned carbohydraIes may
be aI greaIer rísk Ior bíIíary sIudge and gaIIsIones, accordíng Io a Iarge prospecIíve sIudy
presenIed aI Ihe 2011 DígesIíve Dísease Week meeIíng (absIracI 322).
"As a resuII, díeIary modíIícaIíon may reduce a woman's rísk Ior Iormíng gaIIsIones and
gaIIbIadder·reIaIed probIems duríng pregnancy and aIIer Ihe baby ís deIívered," saíd sIudy co·
auIhor CynIhía Ko, MD, assocíaIe proIessor oI medícíne, UníversíIy oI WashíngIon, SeaIIIe.
Women are known Io be aI hígher rísk Ior gaIIsIones, parIícuIarIy duríng pregnancy.
AbouI 10º Io 1Sº oI women Iorm gaIIsIones when Ihey are pregnanI; and choIecysIecIomy ís
Ihe mosI common nonobsIeIríc cause oI maIernaI rehospíIaIízaIíon aIIer deIívery.
Thís sIudy, however, ís Ihe IírsI Io draw a Iínk beIween carbohydraIe consumpIíon
duríng pregnancy and gaIIbIadder dísease.
In Ihe sIudy, Dr. Ko and co·auIhor AIan C. Wong, MD, enroIIed 3,070 pregnanI women
(mean age 2S.2 years) who were aIIendíng Iheír IírsI obsIeIríc cIíníc. ParIícípanIs underwenI
uIIrasounds duríng each IrímesIer oI pregnancy and Iour Io síx weeks aIIer deIívery. LarIy ín
Ihe Ihírd IrímesIer, Ihe women aIso compIeIed a díeIary quesIíonnaíre IhaI Iooked aI average
daíIy consumpIíon oI Ioods, íncIudíng breakdowns oI carbohydraIe, proIeín and Iíber ínIake, as
weII as IoIaI caIoríc and choIesIeroI ínIake. The sIudy díd noI íncIude women who had
gaIIsIones on Iheír IírsI uIIrasound or who had a hísIory oI choIecysIecIomy.
In aII, 10.2º oI Ihe sIudy cohorI Iormed gaIIsIones, íncIudíng S.2º who had new sIudge,
2.8º who Iormed new sIones and 2.3º who had progressíon oI sIudge Io sIones duríng
pregnancy. Women who Iormed new sIones were more IíkeIy Io be Híspaníc, have hígher pre·
pregnancy body mass índex, have gaíned Iess weíghI duríng pregnancy and have consumed
more caIIeíne and aIcohoI. There was no díIIerence beIween raIes oI díabeIes or gesIaIíonaI
díabeIes among Ihese groups, and Ihe IoIaI caIoríc ínIake, and IaI or Iíber consumed díd noI
aIIer Ihe resuIIs.
OveraII, Ihe researchers Iound IhaI women ín Ihe híghesI quarIíIe oI carbohydraIe
consumpIíon had a 2.3·IoId íncreased rísk Ior Iormíng gaIIsIones duríng pregnancy compared
wíIh women ín Ihe IowesI quarIíIe (adjusIed odds raIío |OR], 2.29S; 9Sº conIídence ínIervaI |CI],
1.130·4.661).
The sIudy aIso showed IhaI IrucIose markedIy íncreased rísk Ior gaIIsIones: Women ín
Ihe híghesI quarIíIe Ior IrucIose consumpIíon had Iwíce Ihe rísk Ior Iormíng gaIIsIones
compared wíIh women ín Ihe IowesI quarIíIe (OR, 2.0S4; 9Sº CI, 1.183·3.S68). SIarch, Ioo, was
ímpIícaIed ín gaIIsIone IormaIíon, wíIh women ín Ihe híghesI quarIíIe showíng an 80º íncreased
rísk (OR, 1.812; 9Sº CI, 1.002·3.277).
InIeresIíngIy, Ihe sIudy reveaIed a smaII proIecIíve eIIecI Ior gaIacIose, Iound maínIy ín
daíry producIs. Women ín Ihe híghesI quarIíIe oI gaIacIose consumpIíon had a reduced rísk Ior
gaIIsIones by 30º (OR, 0.664; 9Sº CI, 0.441·0.999). The ínvesIígaIors cauIíoned IhaI Ihe
gaIacIose Iíndíng ís preIímínary and needs IurIher conIírmaIíon.
The new Iíndíngs may be mosI heIpIuI Io obese women and Ihose who have had bíIíary
probIems ín earIíer pregnancíes or príor Io geIIíng pregnanI, saíd Tushar C. PaIeI, MB, ChB, a
gasIroenIeroIogísI aI Mayo CIíníc ín RochesIer, Mínn. "Thís ínIormaIíon ís worIh sharíng wíIh
Ihese paIíenIs because a hígh·carbohydraIe díeI míghI IurIher predíspose Ihem Io sIudge and
sIones," he saíd.
Dr. Wong, an ínIernaI medícíne researcher aI Ihe UníversíIy oI WashíngIon, proposed
IhaI carbohydraIes may exacerbaIe sIudge and gaIIsIone IormaIíon because as pregnancy
progresses, women experíence a ríse ín serum corIísoI, esIrogen, progesIerone and human
pIacenIaI IacIogen. These hormonaI changes have been shown Io produce hyperínsuIínemía and
ínsuIín resísIance, whích, ín Iurn, íncreases bíIe choIesIeroI secreIíon, decreases bíIe acíd
synIhesís and íncreases bíIe choIesIeroI saIuraIíon.
"Thís produces a sIaIe oI bíIe choIesIeroI super·saIuraIíon, whích ís a necessary IacIor ín
gaIIsIone IormaIíon," saíd Dr. Wong.
AI Ihe same Iíme, pregnanI women have decreased gaIIbIadder empIyíng and
gaIIbIadder ejecIíon IracIíon, resuIIíng ín gaIIbIadder sIasís-anoIher rísk IacIor Ior gaIIsIone
IormaIíon.
The ínvesIígaIors aIso beIíeve IhaI hígh carbohydraIe ínIake duríng pregnancy may sIímuIaIe
greaIer ínsuIín reIease, íncreasíng Ihe negaIíve eIIecIs oI hyperínsuIínemía and gaIIbIadder
sIasís.
AddíIíonaIIy, evídence suggesIs IhaI gIucose, IrucIose and sIarch aII may conIríbuIe Io
gaIIsIone IormaIíon ín díIIerenI ways, saíd Dr. Wong. IrucIose, Ior ínsIance, íncreases serum
IrígIyceríde IeveIs and promoIes IepIín resísIance, whích may Iead peopIe Io become ínsuIín
resísIanI.
Mark DeLegge, MD, proIessor oI medícíne aI Ihe DígesIíve Dísease CenIer aI Ihe MedícaI
UníversíIy oI SouIh CaroIína ín CharIesIon, saíd he ís waíIíng Ior IoIIow·up sIudíes beIore
IeIIíng pregnanI paIíenIs Io IímíI Iheír carbohydraIe consumpIíon.
"We currenIIy counseI paIíenIs on eaIíng a Iow·IaI díeI as a mechanísm Ior prevenIíng
bíIíary sIudge and sympIoms oI gaIIbIadder dísease. . Ior Ihe Iíme beíng I am sIíckíng Io whaI
I beIíeve ín, whích ís a baIanced approach Io macronuIríenIs-IaI, carbs, proIeín," he saíd,
addíng IhaI Ihe IaIs come IargeIy Irom omega·3 and omega·9 IaIs Iíke Iísh and oIíves.

hIIp:,,www.gasIroendonews.com,VíewArIícIe.aspx7d=In+Ihe+News&d¸íd=187&í=|uIy+2011&í¸í
d=748&a¸íd=17S48

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