Gallstones in Western Japan. Factors affecting the prevalence of intrahepatic gallstones

In a study from 40 hospitals in Western Japan between 1975 and 1978, intrahepatic gallstones were identified at the first biliary tract operation in 106 patients (a 3.03% prevalence). These were predominantly bilirubin stones. The recurrence rate for patients with intrahepatic stones was the same as for patients with bilirubin stones solely in the common bile duct, suggesting the pathogenetic similarity of these two conditions. The prevalence of intrahepatic stones was 1.5% at urban and 4.97% at rural hospitals (P < 0.005). Rural patients were significantly older than urban patients (P < 0.005), but both groups showed an increasing prevalence with age. However, patients with intrahepatic stones were younger than those with bilirubin stones solely in the common bile duct, reflecting the increased likelihood that stones obstructing the biliary tree in this location would cause hepatic damage, pain, and fever or the possibility that congenital anomalies of the bile ducts might lead to stone formation at an earlier age. Among the 106 patients, only 12% had stones in the intrahepatic ducts alone. The majority of patients with both bilirubin and cholesterol intrahepatic stones had stones throughout the biliary tree simultaneously. The decreasing prevalence of bilirubin stones in Japan may be related to multiple factors including eradication of parasites and westernization of the diet.