More young women may be suffering from gall bladder disease

Poor diet may be a factor, but not all doctors see trend

  • Dr. Atena Rosak, a general surgeon at St. Joseph Medical Center, says she's seen more young female patients with gall bladder problems.
Dr. Atena Rosak, a general surgeon at St. Joseph Medical Center,… (Karl Merton Ferron, Baltimore…)
May 18, 2011|By Frank D. Roylance, The Baltimore Sun

It was a few days after Christmas when 16-year-old Amanda Custer and her mom made a rare stop for a takeout burger. The indulgence ended badly for Amanda.

Soon after, she said, "I felt real nauseous. Food was, like, gross. I got really bad cramps, a whole bunch of heartburn and an upset stomach."

And it didn't go away.

"I would feel OK and try to eat something, and then I'd regret it," she recalled. "The pain afterwards was horrible. A couple of hours after I ate, I'd be going to the bathroom, feeling nauseous."

After a series of tests, Amanda was diagnosed with gall bladder disease. And six weeks after her first attack, the Westminster teen had her gall bladder removed at St. Joseph Medical Center in Towson.

Her surgeon is Dr. Atena Rosak, who does a lot of adult gall bladder surgery. She says she's seeing more and more young people — especially young women — coming under her knife. Amanda, now 17, was her youngest.

"Since August 2010, I have done laparoscopic cholecystectomies on five women [aged] 16 to 25, and seven women 26 to 35," she said. "Only one male less than 35 in those few months."

That's surprising to her. The percentage of people aged 30 or younger among all patients having their gall bladders removed at St. Joseph has increased from 12.5 percent in fiscal year 2007 to 16.3 percent in the 10 months of the current fiscal year, hospital officials said. That's a 30 percent growth in the proportion of young people in the mix.

And it's easy to find comments on online medical sites from frightened teens facing gall bladder surgery and questions from their worried moms.

But what's not clear is whether there's been a real increase nationally in gall bladder disease among young people.

Dr. Anthony N. Kalloo, professor of gastroenterology at the Johns Hopkins University's School of Medicine, is not persuaded.

"The textbook description is an overweight woman in her 40s," he said. "We still see a lot of patients like that. Do we see more patients that are younger? I really do not think so."

"I have had a patient or two in their early 20s or late teens who needed gall bladder removal," Kalloo said. "But it's certainly not an epidemic." Nor could he find anything in the medical literature to support the notion of a trend.

"I'm not saying they're wrong," Kalloo said of the reports from St. Joseph. But he hasn't seen it in his practice. "There's an old saying, that one swallow doesn't make a summer."

At the University of Maryland Medical Center, Dr. Emanuele Lo Menzo said he had not checked his hospital's data for evidence of such a trend. "But I would not be surprised" to find it, he said. In an email message, Lo Menzo, an assistant professor of surgery at the university, said he sees several potential explanations.

"Certainly the change in diet [fattier, more preservatives, larger portions] plays a key role," he said. It's also possible that doctors are spotting incipient gall bladder disease earlier because they're doing more medical imaging.

Finally, Lo Menzo said, "more refined, minimally invasive techniques lead to a higher number of patients willing to undergo the procedure."

As many as 25 million Americans are said to suffer from gall bladder disease, with more than a half-million having their gall bladders removed each year.

The gall bladder is a thumb-sized pouch nestled in the liver, high on the right side of the abdomen. It collects digestive enzymes manufactured in the liver, and stores them as a fluid called bile. When called for by the digestive system, the gall bladder contracts and squeezes the bile through a duct system and into the small intestine.

Several things can go wrong with the gall bladder. Among the most common is the development of gallstones. When the bile is saturated with cholesterol, some of it will begin to crystallize. The crystals combine with calcium and other debris in the bile to form hard "stones."

"Roughly 20 percent of the people walking around out there have stones. They're a fairly common occurrence," said Dr. Richard A. Mackey, a biliary and pancreatic surgeon at St. Joseph.

In some patients, the gallstones grow and become an irritant to the gall bladder. Sometimes they move into the bile duct, causing pain as they pass through. Or they may block the duct, leading to pain, swelling, infection and a medical emergency.

The gall bladder may also become inflamed without the presence of stones. And in both situations its function declines. It is less able to squeeze bile into the digestive tract. That brings on digestive problems in addition to the pain, nausea and fever that typically come with the disease.

The causes aren't entirely clear, Rosak said. But a few things have been linked to a higher risk of developing gall bladder disease.

"We do know the development of … gallstones is related to the amount of fat or calcium in one's diet," she said. "We know that estrogen is related to it."

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