‘Prevalence of gallstone seven times higher in Karachi than other cities of Pakistan’

Speakers at a seminar said on Saturday that Karachiites are more prone to get gallstones, and the prevalence of gallstone is approximately seven times higher in Karachi as compared to other cities of Pakistan.

Gallstones are observed in 8 per cent and 20 per cent of patients over the age of 40 and 60 in Pakistan, respectively. Needless to say, the statistics of laparoscopic gallbladder surgery in Karachi are quite high too, said a health expert at the public awareness seminar titled ‘Ramadan & Gallstone’, organised by Dr Essa Laboratory & Diagnostic Centre, DHA.

The health experts said Karachi is a land of diversification, and amidst it there lies several strange yet verified factors all across it.

“The people residing in Karachi often consume food along with much higher carolers and high content of fat, especially saturated fat and spices. This is closely followed by the fact that they often have low intake of fiber and high intake of refined sugar as well. All the total amount of fat, especially the animal fat, causes the digestion system to work a bit differently, by promoting super saturation and promoting gallstones. These foods also lead to obesity, which is another factor of developing gallstones,” said Prof Ghulam Ali Mandrawala, eminent consultant gastroenterologist & hepatologist at the BHY Hospital, Karachi.

Gallstone disease, a lifestyle-related condition, is multi-factorial in origin, with interaction of both genetic and environmental factors. Common risk factors include obesity, ageing, hormone (estrogen) treatment, pregnancy, diabetes, Crohn’s disease, cystic fibrosis, liver disease and crash dieting.

Taking cholesterol-lowering drugs has been linked with gallstones, lowering blood cholesterol increases bile cholesterol and this, in turn, promotes stone formation. It is proposed that roughly every three females to one male carry gallstones.

Prof Mandrawala said: “Among gallstone population, 24 per cent of the patients get symptoms and complications during their lifetime of having gallstones at one time or the other. Gallstones don't normally cause symptoms. Symptoms occur only when a gallstone gets stuck and blocks the flow of bile through your system.

“If you have symptoms, they may include: A radiating pain in your upper belly, often on the right, just under your ribs especially when you take deep breaths, and continued for several hours, other symptoms include loss of appetite along with nausea, vomiting and Other digestive problems, including indigestion, heartburn and gas. Unlike gas pain, gallbladder pain is not relieved by changing position, burping, or passing gas.”

Prof Mandrawala cautioned people to be mindful about their diet and eat smaller portions of fatty and protein-rich food in the holy month of Ramazan.

Because cholesterol appears to play a role in the formation of gallstones, it's advisable to avoid eating too many foods with a high saturated fat content.

Reduced physical activity, smoking, alcoholism, high calorie diet with refined carbohydrates and low in fiber and unsaturated fats including fried food, whole milk dairy products, fatty red meat and highly processed food like bakery items are all associated with gallstones.

During the month of Ramazan, he said, there are many dietary suggestions to stay healthy while fasting, one of which is a suggestion to avoid consuming spicy foods. This recommendation aims to avoid indigestion, heartburn & triggering of gallbladder pain during fasting.

If your symptoms suggest a gallstone problem, your doctor might first examine your skin for jaundice, and then feel your abdomen to check for tenderness. A blood test may reveal evidence of an obstruction.

Because other digestive problems, such as an infection of the duct, can produce symptoms similar to those of a gallstone attack, the doctor may also run other tests to determine if gallstones are in fact the culprit.

“Generally, abdominal ultrasound is the best and quick imaging test for finding gallstones. It is noninvasive and is 90 per cent to 95 per cent accurate in detecting gallstones. It uses a device called a transducer, which bounces safe, painless sound waves of your organs to create an image or picture of the gallbladder, bile duct, and their contents. If you have gallstones, they will be seen in the image,” said guest speaker Dr Farah Essa Zaidi, consultant radiologist & director radiology at DELD, while explaining the diagnosis of gallstones.

Lead speaker Dr Shiraz Ur Rehman, consultant general & laparoscopic surgeon and assistant professor at Liaquat National Hospital, talked about the surgical management of gallstones disease.

“While the gallbladder serves an important function, it is not essential for a normal, healthy life. When gallstones are persistently troublesome, doctors often recommend removing the organ entirely. Today, however, the most commonly used surgical technique is a much simpler approach known as laparoscopic surgery. The doctor makes several small incisions in the abdomen, then uses special pencil-thin instruments to remove the gallbladder. A tiny microscope and video camera, snaked through the incision to the site, allow the surgeon to view the operation,” he elaborated.

“This operation is considered among the safest of all surgical procedures. Each year about a million Americans have their gallbladder removed. It is also the only treatment method that eliminates the possibility that other gallstones will develop in the future. It has reduced the hospital stay to a day or two. Patients report less pain and are generally able to resume a normal lifestyle in a short period of time, Patients can do most activities including bathing and showering immediately after the surgery,” he added.

“Any abdominal pain should not be ignored. It is essential to treat gallstones due to the high-risk conditions that could occur if left untreated, which include sepsis, infections and even cancer — all of which can be life threatening,” Dr Shiraz further advised.