A Review on Prevalence and Risk Factors of Gallstone Disease in Uganda

Introduction: Globally, the burden and complications from gallstone disease are a major public health issue. It contributes significantly to health care costs and is a common cause of surgical intervention. Most sickle cell disease (SCD) patients have radiolucent stones, probably of pigment type, containing little or no calcium. While most patients with gallstones are asymptomatic, only 20% after 10 years become symptomatic. The prevalence of gallstone disease varies among different populations. The purpose of this review is to understand the profile of gallstone disease patients in Uganda which may facilitate better treatment options and may reduce the complications of gallstone disease.

Discussion: In Uganda, the prevalence of gallstone disease is high in patients presenting to hospital. The risk factors for gallstone disease include a previous history of biliary symptoms and the use of hormonal contraceptives. SCD in Sub-Saharan Africa is also a major health problem and a risk factor for gallstone disease. Acute abdominal pain in SCD patients was thought to be due to sickle cell crises until the advent of ultrasonography. Differentiating between acute cholecystitis and sickle cell crises may be difficult. An increased production of unconjugated bilirubin from a sickle cell crisis may precipitate acute cholecystitis. While in SCD patients with acute cholecystitis, a haemolytic crisis may occur.
Conclusions: While the prevalence of gallstone disease in Uganda from hospital-based studies is high the majority of patients are symptomatic at presentation. In the general population, the prevalence of gallstones may be determined using abdominal ultrasound as a screening tool. Any SCD patient who has an abdominal crisis should have an abdominal ultrasound to prevent missing any episodes of acute cholecystitis.