Gallstone disease in children
DOI:
https://doi.org/10.15574/SP.2023.136.79Keywords:
children, gallstone disease, cholelithiasis, cholecystectomy, bile acids, bilirubin, cholesterolAbstract
The prevalence of gallstone disease among children is 0.13-1.9%. Cholelithiasis in children is a multifactorial disorder. Scientific data analysis indicates a diversity of pathogenetic mechanism of gallstone formation.
The purpose of the review is to summarize the scientific data about risk factors, clinical features, diagnosis and treatment of gallstone disease in children.
Based on the literature data, the main factors for the disease are genetic, metabolic, low-calorie diet, nutritional disorders, liver and small intestine diseases. The main pathogenetic mechanisms of gallstone formation are liver dyscholia, disorders of enterohepatic circulation of bile acids, increased erythrocyte hemolysis and erythrocyte enzyme system insufficiency, a decrease in hepatic enzyme activity, impairment of gallbladder motility due to decreased sensitivity to cholecystokinin. Most children undergo asymptomatic gallstone disease: clinical features are absent, concrements in the gallbladder or bile ducts appear as accidental findings during ultrasound examination. The first stage of diagnosing cholelithiasis is an abdominal ultrasound examination. In case of absence of concrements during ultrasound examination and presence of typical clinical picture of cholelithiasis, endoscopic ultrasound and magnetic resonance cholangiopancreatography are prescribed. To reduce biliary pain, non-steroidal anti-inflammatory drugs and analgesics are required. The only way to treat symptomatic form of gallstone disease is cholecystectomy. The asymptomatic form is subject to observation without treatment.
For the treatment and prevention of cholelithiasis, it is not recommended to take bile acid preparations due to the low effectiveness and frequency of relapses in the formation of stones after their complete dissolution.
Conclusions. The incidence of gallstone disease among children and adolescents increases and more than half of patients has asymptomatic form. During the treatment of patients with cholelithiasis, cholecystectomy or observation tactics are used, depending on the clinical form of the disease. Prevention of gallstone disease relies on healthy lifestyle, weight loss for the obese children, physical activity, diet high in fiber and calcium.
The authors declare that they have no conflicts of interest.
References
Agincorresponding M, Kayar Y. (2021) Gallstone Frequency in Children With Celiac Disease. Cureus. 13(1): e12767. https://doi.org/10.7759/cureus.12767; PMid:33614356 PMCid:PMC7888360
Bălănescu RN, Bălănescu L, Drăgan G et al. (2015). Biliary Lithiasis with Choledocolithiasis in Children Chirurgia (Bucur). 110(6): 559-561.
Chamorro CC, Arteaga P, Paredes C et al. (2020). Cholelithiasis and associated complications in pediatric patients. Cir. Pediatr. 33: 172-176.
Chou T-S, Lin C-L, Chen L-W et al. (2023). Waist-to-height ratio for the prediction of gallstone disease among different obesity indicators. Obes Sci Pract. 9(1): 30-41. https://doi.org/10.1002/osp4.650; PMid:36789027 PMCid:PMC9913192
Cortés VA, Barrera F, Nervi F. (2020). Pathophysiological connections between gallstone disease, insulin resistance, and obesity. Obes. Rev. 21: e12983. https://doi.org/10.1111/obr.12983; PMid:31814283
Demehri FR, Alam HB. (2016). Evidence-based management of common gallstone-related emergencies. J Intensive Care Med. 31(1): 3-13. https://doi.org/10.1177/0885066614554192; PMid:25320159
Di Ciaula A, Portincasa P. (2018) Recent advances in understanding and managing cholesterol gallstones. F1000Res. 7: F1000 Faculty Rev-1529. https://doi.org/10.12688/f1000research.15505.1; PMid:30345010 PMCid:PMC6173119
Di Ciaula A, Wang DQ, Portincasa P. (2018). An update on the pathogenesis of cholesterol gallstone disease. Curr Opin Gastroenterol. 34(2): 71-80. https://doi.org/10.1097/MOG.0000000000000423; PMid:29283909 PMCid:PMC8118137
Diez S, Müller H, Weiss C et al. (2021). Cholelithiasis and cholecystitis in children and adolescents: Does this increasing diagnosis require a common guideline for pediatricians and pediatric surgeons? BMC Gastroenterol. 21(1): 186. https://doi.org/10.1186/s12876-021-01772-y; PMid:33882844 PMCid:PMC8061037
EASL. (2016). Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 65: 146-181. https://doi.org/10.1016/j.jhep.2016.03.005; PMid:27085810
Goldman DA. (2020). Gallbladder, Gallstones, and Diseases of the Gallbladder in Children. Pediatr. Rev. 41 (12): 623-629. https://doi.org/10.1542/pir.2019-0077; PMid:33262152
Gutt C, Schläfer S, Lammert F. (2020). The Treatment of Gallstone Disease. Dtsch Arztebl. 117 (9): 148-158. https://doi.org/10.3238/arztebl.2020.0148; PMCid:PMC7132079
Ha BJ, Park S. (2018). Classification of gallstones using fourier-transform infrared spectroscopy and photography. Biomaterials Research. 22: Article 18. https://doi.org/10.1186/s40824-018-0128-8; PMid:30038795 PMCid:PMC6052647
Liang KW, Huang HH, Wang L et al. (2021). Risk of gallstones based on ABCG8 rs11887534 single nucleotide polymorphism among Taiwanese men and women. Gastroenterol. 21(1): 468. https://doi.org/10.1186/s12876-021-02060-5; PMid:34906072 PMCid:PMC8672562
Lichtman М, Kaushansky K, Prchal J et al. (2022). Williams Manual of Hematology. 10th Edition. McGraw Hill. Medical: 688.
Littlefield А, Lenahan C. (2019) Cholelithiasis: presentation and management. J Midwifery Womens Health. 64(3): 289-297. https://doi.org/10.1111/jmwh.12959; PMid:30908805
Luo J, Yang H, Song BL. (2020). Mechanisms and regulation of cholesterol homeostasis. Nat. Rev. Mol. Cell Biol. 21: 225-245. https://doi.org/10.1038/s41580-019-0190-7; PMid:31848472
Murphy PB, Vogt KN, Winick-Ng J et al. (2016). The increasing incidence of gallbladder disease in children: A 20 year perspective. J. Pediatr. Surg. 51: 748-752. https://doi.org/10.1016/j.jpedsurg.2016.02.017; PMid:26951963
Nissinen MJ, Pitkänen N, Simonen P et al. (2018). Genetic polymorphism of sterol transporters in children with future gallstones. Dig. Liver Dis. 50: 954-960. https://doi.org/10.1016/j.dld.2018.04.007; PMid:29764733
Papadopoulos V, Filippou D, Mimidis K. (2020). Smoking habits and gallbladder disease: a systematic review and meta-analysis study. Hippokratia. 24(4): 147-156.
Pogorelić Z, Lovrić M, Jukić M, Perko Z. (2022). The Laparoscopic Cholecystectomy and Common Bile Duct Exploration: A Single-Step Treatment of Pediatric Cholelithiasis and Choledocholithiasis. Children (Basel). 9(10): 1583. https://doi.org/10.3390/children9101583; PMid:36291520 PMCid:PMC9601212
Portincasa P, Di Ciaula A, Bonfrate L et al. (2023). Metabolic dysfunction-associated gallstone disease: expecting more from critical care manifestations. Intern Emerg Med. 18(7): 1897-1918. https://doi.org/10.1007/s11739-023-03355-z; PMid:37455265 PMCid:PMC10543156
Rebholz C, Krawczyk M, Lammert F. (2018) Genetics of gallstone disease. Eur J Clin Invest. 48(7): e12935. https://doi.org/10.1111/eci.12935; PMid:29635711
Reichert MC, Lammert F. (2018). ABCB4 Gene Aberrations in Human Liver Disease: An Evolving Spectrum. Semin Liver Dis. 38(4): 299-307. https://doi.org/10.1055/s-0038-1667299; PMid:30357767
Rothstein DH, Harmon CM. (2016). Gallbladder disease in children. Semin. Pediatr. Surg. 25: 225-231. https://doi.org/10.1053/j.sempedsurg.2016.05.005; PMid:27521713
Schatz SB, Jüngst C, Keitel-Anselmo V et al. (2018). Phenotypic spectrum and diagnostic pitfalls of ABCB4 deficiency depending on age of onset. Hepatol. Commun. 2: 504-514. https://doi.org/10.1002/hep4.1149; PMid:29761167 PMCid:PMC5944585
Shabanzadeh DM. (2018). New determinants for gallstone disease? Dan Med J. 65(2): B5438.
Shabanzadeh DM, Skaaby T, Sørensen LT et al. (2017). Metabolic biomarkers and gallstone disease - a population-based study Scand J Gastroenterol. 52(11): 1270-1277. https://doi.org/10.1080/00365521.2017.1365166; PMid:28799434
Shaikh NM. (2021). Gall Stones in Pediatric Population. dоі: 10.5772/intechopen.99020.
Sun H, Warren J, Yip J, Ji Y et al. (2022). Factors Influencing Gallstone Formation: A Review of the Literature. Biomolecules. 12(4): 550. https://doi.org/10.3390/biom12040550; PMid:35454138 PMCid:PMC9026518
Tazuma S, Unno M, Igarashi Y et al. (2017). Evidence-based clinical practice guidelines for cholelithiasis. J Gastroenterol. 52(3): 276-300. https://doi.org/10.1007/s00535-016-1289-7; PMid:27942871
Wang HH, Portincasa P, Liu M, Wang DQ. (2022). Genetic Analysis of ABCB4 Mutations and Variants Related to the Pathogenesis and Pathophysiology of Low Phospholipid-Associated Cholelithiasis. Genes (Basel).13(6): 1047. https://doi.org/10.3390/genes13061047; PMid:35741809 PMCid:PMC9222727
Wyllie R, Hyams JS, Kay M. (2016). Pediatric Gastrointestinal and Liver Disease. 5th ed. Philadelphia, PA: Elsevier.
Vitale G, Gitto S, Raimondi F et al. (2018). Cryptogenic cholestasis in young and adults: ATP8B1, ABCB11, ABCB4, and TJP2 gene variants analysis by high-throughput sequencing. J Gastroenterol. 53(8): 945-958. https://doi.org/10.1007/s00535-017-1423-1; PMid:29238877
Zdanowicz K, Daniluk J, Lebensztejn DM, Daniluk U. (2022). The Etiology of Cholelithiasis in Children and Adolescents. Int J Mol Sci. 23(21): 13376. https://doi.org/10.3390/ijms232113376; PMid:36362164 PMCid:PMC9657413
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