Elsevier

The Lancet

Volume 341, Issue 8836, 2 January 1993, Pages 8-10
The Lancet

ARTICLES
An explanation for gallstones in normal-weight women: slow intestinal transit

https://doi.org/10.1016/0140-6736(93)92479-DGet rights and content

Abstract

Many cases of gallstones can be explained in terms of the established risk factors, especially obesity. However, gallstones develop in some women who are not obese, and the causes are unknown. Biochemical studies have shown that slow intestinal transit is associated with lithogenic bile. We have tested the hypothesis that intestinal transit is abnormally slow in normal-weight women with gallstones.

In a population survey, 1058 women aged 25-69 years, registered with general practitioners in Bristol, UK, underwent cholecystosonography. Gallstones were identified in 48 women, of whom 15 were of normal weight (body mass index ≤25 kg/m2). These women and age-matched controls with healthy gallbladders then underwent measurement of whole-gut transit time (WGTT); the measurement was done directly when possible, or calculated from records of three defaecations. The mean WGTT was significantly longer in the women with gallstones than in the controls (82 vs 63 h; mean difference 19, 95% Cl 2-37 h). Stool output was also lower in the women with gallstones (74 [SD 54] vs 141 [56] g per 24 h, p=0·015). There was no significant difference between cases and controls in body mass index, waist-hip circumference ratio, parity, plasma triglyceride concentration, or alcohol intake. Normal-weight women with gallstones tend to have slow intestinal transit and this feature could explain why they have gallstones.

References (31)

  • C. Thijs et al.

    Serum lipids and gallstones: a case-control study

    Gastroenterology

    (1990)
  • Ts Low-Beer et al.

    Colonic bacterial activity, biliary cholesterol saturation, and pathogenesis of gallstones

    Lancet

    (1978)
  • W. Osler

    The principles and practice of medicine

    (1982)
  • B. Leijd

    Cholesterol and bile acid metabolism in obesity

    Clin Sci

    (1980)
  • A. Reuben et al.

    Bile lipid secretion in obese and non-obese individuals with and without gallstones

    Clin Sci

    (1985)
  • Bg Stone et al.

    Gallbladder emptying stimuli in obese and normal-weight subjects

    Hepatology

    (1992)
  • T. Jo̸rgensen

    Gallstones in a Danish population. Relation to weight, physical activity, smoking, coffee consumption, and diabetes mellitus

    Gut

    (1989)
  • Km Maclure et al.

    Weight, diet and the risk of symptomatic gallstones in middle-aged women

    N Engl J Med

    (1989)
  • T. Jo̸rgensen

    Gallstones in a Danish population: familial occurrence and social factors

    J Biosoc Sci

    (1988)
  • T. Jo̸rgensen

    Gallstones and plasma lipids in a Danish population

    Scand J Gastroenterol

    (1989)
  • L. Barbara et al.

    A population study on the prevalence of gallstone disease: the Sirmione study

    Hepatology

    (1987)
  • T. Jo̸rgensen

    Gallstones in a Danish population: fertility period, pregnancies, and exogenous female sex hormones

    Gut

    (1988)
  • B. Lewis

    Influence of diet, energy balance and hormones on serum lipids. In: The hyperlipidaemias: clinical and laboratory practice

    (1976)
  • AF. Hertz

    Constipation and allied disorders

    (1909)
  • Sn Marcus et al.

    Intestinal transit, deoxycholic acid and the cholesterol saturation of bile: three inter-related factors

    Gut

    (1986)
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