A recent Canadian study is hoping to change the way doctors think about gallstones -- a condition historically associated with adults -- after finding a "significant rise" in the number of children with the condition.
Gallstones are hardened deposits of bile that can form in your gallbladder. They can be as small as a grain of sand or as big as a golf ball. The most common type of gallstone is made of cholesterol, and occurs when your bile does not have enough chemicals to break down the cholesterol excreted by your liver.
Treatment usually involves medications to help dissolve the gallstones, or, in more severe cases, surgery to the remove the patient's gallbladder -- a cholecystectomy.
The study, based out of London, Ont., looked at patients from across the province under the age 18 who underwent a cholecystectomy between 1993 and 2012.
The researchers found a 62-per-cent rise in incidences between 1993 to 1996 and 2009 to 2012. That's an increase of 8.8 cases per 100,000 to 13.
"So it's a very broad range, actually, which is surprising and that also something that's very alarming because we are seeing patients as young as eight who have gallstones," said lead author Dr. Sarah Jones, a pediatric surgeon at London Health Sciences.
There are several complications related to gallstones, including:
- The inflammation of the gallbladder if there is a blockage, which can cause severe pain and fever
- A blockage of bile duct, which can lead to infection and jaundice
- A blockage of the pancreatic duct, which can lead to pancreatitis
- People with a history of gallstones also have an elevated risk of gallbladder cancer
Jones said the condition has been typically considered an "adult disease," so seeing a rise in incidences of gallbladder removal surgeries in children is worrisome.
"It is very concerning," she said.
"We always thought this was a disease of older patients, and we tended to associate it with patients who were obese, had unhealthy lifestyles and who didn't exercise. But we're seeing this in children, so I think this reflects a possible problem that we're running into that our children are not as healthy as we think they are."
Obesity is considered a significant risk factor for gallstones. In overweight patients with gallstones, the liver overproduces cholesterol, which is delivered into the bile and becomes supersaturated.
Similar studies have also been performed in the United States and United Kingdom.
Dr. Mark Davenport, who co-authored a 2013 study that found a three-fold increase in paediatric cholecystectomies in England since 1997, said the rise in gallstones is likely a "Western phenomenon."
"We've got some data from hospitals in the U.S., we've got some data from South American regions, there's precious little from Europe, but all of them seem to show the same thing, and that is a dramatic increase in the operations to remove gallstones," said Davenport.
"So it is probably a factor of our way of life and the increasing levels of being overweight and having obesity."
And with childhood obesity on the rise, researchers are warning doctor to be on the lookout for even more cases of gallbladder disease in children.
But symptoms can be fairly general, including abdominal pain, fever and vomiting, and Jones said doctors need to be vigilant.
"Don't think because a patient is 12, 13, 14 that it couldn't be a problem with the gallbladder and we really need to identify those patients because they can run into significant problems if the disease goes unrecognized and they have a complication from it," she said.
Jones added that there is little information on the long-term effects of gallbladder removal.
"I worry because this is what we are doing to our children and they are our future … we are putting them through an operation (and) we are leaving them with potential consequence," she said.
"And it is alluding to the fact that our pediatric world is not as healthy as it should be, certainly in Canada."
With a report from CTV’s medical affairs specialist Avis Favaro and producer Elizabeth St. Philip
