|Year : 2020 | Volume
| Issue : 2 | Page : 63-67
Serum lipid profile in patients with cholesterol containing gallstones: A study from South India
Prema Saldanha1, Priya Suneja1, Anand Raj2
1 Department of Pathology, Yenepoya Medical College, Mangalore, Karnataka, India
2 Yenepoya Medical College, Mangalore, Karnataka, India
|Date of Submission||11-May-2020|
|Date of Acceptance||11-May-2020|
|Date of Web Publication||19-Jun-2020|
Dr. Prema Saldanha
“Flushing Meadows,” Pandeshwar, Mangalore 575001, Karnataka.
Source of Support: None, Conflict of Interest: None
Background: Cholelithiasis is a common disease and notable advances have been made in studying the possible causes and mechanisms involved. It is not only important to study the prevalence of gallstone disease regionally, but also to explore the demographic and biological markers related to the development of gallstone disease, so that appropriate preventive measures may be undertaken. Many previous studies have shown a positive correlation between altered lipid profile and formation of gallstones, whereas some show no definite correlation between the two. Objective: This work aimed to study the association of lipid profile with cholelithiasis in our geographic region. Materials and Methods: This was a retrospective study of cases who underwent cholecystectomy for cholelithiasis, obtained from the archives of the Department of Pathology. The lipid profiles of these patients were retrieved from the laboratory records and analyzed. Results: The number of patients with mixed stones (cholesterol and pigment) accounted for 85% and pure cholesterol stones were seen 15% of the cases. Deranged lipid profile was observed in 57 (95%) of the cases. The most common abnormality was increased levels of low-density lipoprotein /very low density lipoprotein with decreased high-density lipoprotein. Conclusion: In this study, it was found that a significant number of patients with cholesterol-containing stones had a deranged lipid profile. This suggests that hyperlipidemia plays an important role in the lithogenesis of cholesterol-rich gallstones.
Keywords: Cholesterol stones, gallstones, lipid profile
|How to cite this article:|
Saldanha P, Suneja P, Raj A. Serum lipid profile in patients with cholesterol containing gallstones: A study from South India. MGM J Med Sci 2020;7:63-7
|How to cite this URL:|
Saldanha P, Suneja P, Raj A. Serum lipid profile in patients with cholesterol containing gallstones: A study from South India. MGM J Med Sci [serial online] 2020 [cited 2021 Oct 21];7:63-7. Available from: http://www.mgmjms.com/text.asp?2020/7/2/63/287170
| Introduction|| |
Gallstone disease is a common disease, seen affecting adults all over the world and represents one of the most common causes of morbidity. In India, the prevalence of gallstones varies in different regions. The pathogenesis of cholelithiasis is multifactorial. Some of the important risk factors are female gender, age, genes, race, obesity, rapid weight loss, glucose intolerance, insulin resistance, high dietary glycemic load, alcohol use, diabetes mellitus, hypertriglyceridemia, drugs, and pregnancy.,,,,
Notable advances have been made in studying the mechanisms responsible for the formation of gallstones. From a public health standpoint, it is not only important to study the prevalence of gallstone disease regionally, but it is also necessary to explore the demographic and biological markers related to the formation of gallstones.
The risk factors contributing to the development of gallstones need to be identified, so that appropriate preventive measures can be undertaken. Some of the previous studies show a positive correlation between altered lipid profile and formation of gall stones, whereas some show no definite correlation between the two.
As the role of hyperlipidemia in the development of cholesterol-rich gallstones is not clearly established, this study is conducted to know the association of lipid profile with cholelithiasis in our geographic region, which has not been done before.
| Materials and methods|| |
This was a retrospective study of 60 consecutive cases who underwent cholecystectomy for cholelithiasis, obtained from the archives of the Department of Pathology.
The study population included the patients diagnosed to have cholelithiasis who were admitted to the Medical College Hospital and who underwent cholecystectomy.
Sixty cases. [Sample size calculated as per SPSS version 22 with power of the test as 80%].
The inclusion criteria of the study included all patients with cholesterol-rich gallstones and with available lipid profiles.
The exclusion criteria of the study included the cases with acalculous cholecystitis, cases with tumors of the gall bladder, and patients whose lipid profile was not performed.
Data collection procedure and methodology
The demographic details of the patients who underwent cholecystectomy for cholelithiasis were retrieved from the archives of the Department of Pathology.
The type of stones as recorded during the assessment of the gross morphology of the cholecystectomy specimens, and the histological changes from the paraffin-embedded and hematoxylin and eosin stained slides were recorded. The lipid profiles of these patients were retrieved from the laboratory records. The lipid profile was performed using VITROS 5600 Biochemistry Analyzer, Ortho Clinical Diagnostics and included the following: total cholesterol (0–200mg/dL), triglycerides (0–150mg/dL), high-density lipoprotein (HDL) (40–60mg/dL), low-density lipoprotein (LDL) (0–100mg/dL), and very low density lipoprotein (VLDL) (0–30mg/dL).
The study was started after obtaining permission from the Institutional Ethics Committee (IEC).
| Results|| |
In this study, of the 60 cases, 70% of cases were females and 66.6% were above 40 years of age. The age of the patients ranged from 17 to 72 years. Pain in the right hypochondrium was the most common symptom seen in 73.3% of the patients in our study, followed by pain in the epigastric region seen in 26.7%.
The number of patients with mixed stones (cholesterol and pigment) accounted for 85% and cholesterol stones were seen in 15% of the cases. Multiple stones were seen in 77.33% of the cases. The sizes of the gallstones varied from 0.2 to 3cm with maximum stones measuring 0.2cm. The gallbladders were examined histopathologically and the type of inflammatory cell infiltrate was recorded. Lymphocytes were seen in all the cases, 39 cases showed lymphocytes and plasma cells along with eosinophils in another 17 cases, and neutrophils in another 4 cases. The inflammatory infiltrate was only mild to moderate in 95% of the cases.
The lipid profile was recorded in all the cases. Deranged lipid profile was observed in 57 (95%) of the cases, which was significant. The three patients who did not show a deranged lipid profile were female and under the age of 40 years. The most common derangement in the lipid levels were reduced HDL and increased LDL/VLDL. Although there was an altered lipid profile, the mean values and standard deviation were within the normal range. The various patterns of deranged lipids are shown in [Table 1].
|Table 1: Various patterns in the deranged lipid profiles in patients with cholelithiasis|
Click here to view
The most common derangement was increased LDL/VLDL with decreased HDL, followed by increased triglycerides with increased LDL/VLDL and decreased HDL. As the number of cases in each category was small, it was not possible to study the significance of any particular pattern of lipid derangement.
| Discussion|| |
Cholelithiasis is a common disease, affecting adults all over the world and represents one of the most common causes of morbidity. In India, the prevalence of cholelithiasis varies in different regions. In this study, the age of the patients ranged from 17 years to 72 years and 70% of the cases were females which is similar to one study, but in other studies,, the ratio of female to male patients was lower. In this study, the number of cases with mixed stones (cholesterol and pigment) accounted for 85%, and pure cholesterol stones were seen in 15% of the cases. This was similar to the study by Pradhan et al., but in other studies,, the number of mixed stones was lower.
There are mainly two types of gallstones, the common ones are cholesterol stones (pure or mixed), containing more than 50% of crystalline cholesterol monohydrate. The other type are pigment stones (black or brown) composed predominantly of bilirubin calcium salts., The primary event in the pathogenesis of cholesterol gallstones is an altered lipid metabolism because of which there is a relative increase in the cholesterol levels in the bile.
Cholesterol and triglycerides are the major constituents of the cholesterol-containing gallstones. Cholesterol gallstone pathogenesis involves cholesterol saturation of the bile duct due to the hypersecretion of cholesterol from the liver.
High serum levels of total cholesterol, triglycerides, LDL, and low serum levels of HDL generally characterize hyperlipidemia. The most common abnormality in lipid levels in our study was reduced HDL and increased LDL/VLDL. The most common derangement was increased LDL/VLDL with decreased HDL, followed by increased triglycerides with increased LDL/VLDL and decreased HDL. The results are compared with other studies from India [Table 2] and also other Asian countries as the study was done in the Indian population [Table 3].
|Table 2: Findings of the various Indian studies with altered lipid profiles in cholelithiasis|
Click here to view
|Table 3: Findings of studies from various Asian countries where altered lipid profiles seen in cholelithiasis|
Click here to view
Most of the studies conducted are from Northern India and very few studies are from the South. In many studies, a positive correlation has been observed between increased total cholesterol, LDL, and triglyceride levels, along with decreased HDL levels, in both female and male patients with cholelithiasis.,,
In one study, high triglycerides and low HDL have been most consistently associated with cholelithiasis, whereas total cholesterol and LDL have shown less association. Other studies showed that in patients with gallstone disease some altered levels of total cholesterol, triglyceride and LDL concentration, and low levels of HDL in different combinations had a significant increase in patients with cholesterol calculi.,,,
In studies from other Asian countries, a positive correlation has been observed between increased total cholesterol, LDL, and triglyceride levels, along with decreased HDL levels, in both female and male patients with cholelithiasis.,
In one study, high triglycerides and low HDL were found to be most consistently associated with cholelithiasis, whereas total cholesterol and LDL had less association. Other studies showed that in patients with gallstone disease, some altered levels of total cholesterol, triglyceride, and LDL concentration, as well as low levels of HDL in different combinations had a significant increase in patients with cholesterol calculi., Studies have also shown no association with hyperlipidemia.
Changes in lipid profile in cholelithiasis are significant and interesting. The perturbation in the delicate balance among components of the lipid profile is of crucial importance and may have a definitive role in it leading to the development of cholelithiasis. With larger studies, the possibility of using the lipid profile as a biomarker for the prediction of gallstones may be considered. This may be helpful to implement preventive strategies such as dietary and lifestyle modifications in patients with altered serum lipid profiles in the prevention of gallstones. Changes in the level of lipid profile may be used as markers for gallstone formation.,,
Generally, gallstones are regarded only as a surgical condition needing cholecystectomy. They should now be regarded as a marker of an underlying metabolic disorder and investigated and treated accordingly.,, Studies on lipid profile in patients with cholelithiasis will definitely throw some light on the pathogenesis of cholesterol-rich gallstones. This would help patients to understand the relationship between dietary fat and the risk for gallstone disease. Evaluation of lipid profile should be done routinely in gallstone diseases and suitable lifestyle modification and use of antihyperlipidemic drugs may be effective.
| Conclusion|| |
Gallstones are formed because of impaired metabolic regulation of the human body. Abnormal lipid metabolism is partly responsible for the pathogenesis of gallstones mainly rich in cholesterol. Thus, abnormalities of serum lipids would reflect the possibility of the formation of cholesterol gallstones. It is recommended that all patients who have cholelithiasis should now have a full lipid profile as a routine part of their clinical assessment. If dyslipidemia is identified, lifestyle modification and or medical management should be started.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kumar V, Abbas AK, Aster JC. Robbins and Cotran Pathological Basis of Disease: South Asia Edition. Vol. I. 9th ed. New Delhi, India: Reed Elsevier India Private Limited; 2014. p. 876-8.
Gurusamy KS, Davidson BR. Gallstones. BMJ 2014;348:g2669.
Reshetnyak VI. Concept of the pathogenesis and treatment of cholelithiasis. World J Hepatol 2012;4:18-34.
Adsay VN. Gallbladder, extrahepatic biliary tree, and ampulla. In: Mills SE, Joel K. Greenson JK, Jason L Hornick JL, Teri A. Longacre TA, Victor E. Reuter VE, editors. Sternberg’s Diagnostic Surgical Pathology. 6th ed. 2 vols. Philadelphia, PA: Wolters Kluwer; 2015. p. 1770.3
Nagaraj SK, Paul P, Kumar MK, Muninarayanappa S, Anantharamaiah H. Risk factors and the biochemical evaluation of biliary calculi in rural Kolar, Karnataka, India: A rural perspective of an urban disease. J Clin Diagn Res 2012:6:364-8.
Mohan H, Punia RP, Dhawan SB, Ahal S, Sekhon MS. Morphological spectrum of gallstone disease in 1100 cholecystectomies in North India. Indian J Surg 2005;67:140-2.
Narayanasamy K, Kirankumar B, Karthick R. A cross sectional study on gallstone disease and its risk factors in a tertiary care hospital of South India. JSM Gastroenterol Hepatol 2017;5:1090.
Al-Saadi NH, Al-Ardhi SA. Biochemical and demographical study of lipid profile in sera of patients with gallstone. Iraqi J Sci 2012;53:760-8.
Kaur A, Dubey VK, Mehta KS. Gallbladder mucosal changes associated with chronic cholecystitis and their relationship with carcinoma gallbladder. JK Sci 2012;14:89-92.
Pradhan SB, Joshi MR, Vaidya A. Prevalence of different types of gallstone in the patients with cholelithiasis at Kathmandu Medical College, Nepal. Kathmandu Univ Med J (KUMJ) 2009;7:268-71.
Chandran P, Kuchhal NK, Garg P, Pundir CS. An extended chemical analysis of gallstone. Indian J Clin Biochem 2007;22:145-50.
Selvi TR, Sinha P, Subramaniam PM, Konapur PG, Prabha CV. A clinicopathological study of cholecystitis with special reference to analysis of cholelithiasis. Int J Basic Med Sci 2011;2: 68-72.
Taher MA. Descriptive study of cholelithiasis with chemical constituents analysis of gallstones from patients living in Baghdad, Iraq. Int J Med Med Sci 2013;5:19-23.
Harish B. A cross sectional study on causes and risk factors of gallstone disease among patients with symptomatic cholelithiasis. Int J Nurs Res Pract 2014;1:20-4.
Channa NA, Khand F, Ghanghro AB, Soomro AM. Quantitative analysis of serum lipid profile in gallstone patients and controls. Pak J Anal Environ Chem 2010;11:59-65.
Aulakh R, Mohan H, Attri AK, Kaur J, Punia RP. A comparative study of serum lipid profile and gallstone disease. Indian J Pathol Microbiol 2007;50:308-12.
Malik AA, Wani ML, Tak SI, Irshad I, Ul-Hassan N. Association of dyslipidaemia with cholilithiasis and effect of cholecystectomy on the same. Int J Surg 2011;9:641-2.
Ahmed MA, Das BB, Das SK, Sahoo N, Padhy L, Rath SK. Quantitative analysis of serum lipid profile in patients with gallstone disease. J Evidence Based Med Healthcare 2015;2:2188-203.
Kumar J, Chatterjee S, Dinda S, Ghosh A, Mallick NR, Rahman QM. Dyslipidemia and gall stone disease; a search for their causal relationship. J Surg Arts (Cer San D)2016;9:67-70.
Gul H, Ayub M, Akhtar A. Mean serum calcium and lipid profile in patients with gallstone disease in Southern Punjab. Pak J Med Health Sci 2016;10:548-51.
Kaur H, Dil JS, Kaur H, Jaspreet. Lipid profile of blood and bile in patients with gall stone disease. J Med Sci Clin Res 2018;6:1080-6.
Janugade H, Chhabra R. A study of association of lipid profile and gallstone disease at tertiary health care centre. MedPulse Int J Surg 2018;6:34-6.
Devaki RN, Virupaksha HS, Rangaswamy M, Deepa K, Goud BKM, Nayal B. Correlation of serum lipids and glucose tolerance test in cholelithiasis. Int J Pharm BioSci 2011;2:224-8.
Andreotti G, Chen J, Gao YT, Rashid A, Chang SC, Shen MC, et al
. Serum lipid levels and the risk of biliary tract cancers and biliary stones: A population-based study in china. Int J Cancer 2008;122:2322-9.
Shrestha KB, Dahal P, Shah LL, Singh R. Relation of lipid profile, BMI and cholelithiasis in Nepalese population. Postgrad Med J NAM 2012;12:40-4.
Batajoo H, Hazra NK. Analysis of serum lipid profile in cholelithiasis patients. J Nepal Health Res Counc 2013;11:53-5.
Rasheed RA. Lipid profile and hematological changes in gallstone patients. J Univ Zakho 2014;2:49-53.
Weerakoon HT, Ranasinghe S, Navaratne A, Sivakanesan R, Galketiya KB, Rosairo S. Serum lipid concentrations in patients with cholesterol and pigment gallstones. BMC Res Notes 2014;7:548.
Bhatta S, Singh S. Study of gallbladder lesions and its relationship with serum lipid profile. Int J Adv Med 2018;5:1245-9.
Haq AMM, Giasuddin ASM, Jhuma KA, Choudhury MAM. Effect of cholecystectomy on lipid profile in Bangladeshi patients with cholelithiasis. J Metab Synd 2016;5:1.
Sabanathana S, Oomeera S, Jenkinson LR. Cholecystectomy or cholelithiasis: A missed marker for hyperlipidaemia? A combined retrospective and prospective study. Gastroenterol Res 2008;1:29-32.
Jain A, Singh MM, Choudhary P. Effect of cholecystectomy on serum lipid profile. Global J Res Anal 2018;7:428-9.
[Table 1], [Table 2], [Table 3]