The right upper quadrant

July 2013

FocusThe right upper quadrant

Gallbladder disease

Volume 42, No.7, July 2013 Pages 443-443

Clare Bayram

Lisa Valenti

Graeme C Miller

Gallbladder disease (GBD) is a common cause of upper abdominal pain.1 Prevalence of GBD increases with age, and is more common in women than men. United States population prevalence estimates indicate that 17% of women and 8% of men have GBD.2,3 Although common, it is often asymptomatic.1 We analysed data collected in the BEACH (Bettering the Evaluation and Care of Health) program from January 2010 to December 2012 to describe general practitioners’ management of GBD when it is an ‘active’ clinical problem.

Gallbladder disease was managed at a rate of 0.2 per 100 encounters in BEACH, suggesting approximately 380 000 GBD patient-doctor encounters nationally per year. Gallbladder disease was managed significantly more often among women (at 0.22% of their encounters) than among men (0.15%), reflecting its higher prevalence in women. However, there was no significant change in the age-specific management rate, with patients in all age groups from 25 years onward having similar likelihood of GBD management.

Management

More than half (54.4%) of the GBD problems managed were new problems, a significantly larger proportion than the average for all problems (38.1%) recorded in BEACH in 2011–12.4 Medications were prescribed, advised for over-the-counter purchase, or supplied by the GP at a rate of 42.6 per 100 GBD problems, significantly lower than average for all problems (69.6) in BEACH. The most common medications were the analgesic, paracetamol/codeine and the anticholinergic, hyoscine butylbromide. Clinical treatments were provided at a rate of 25.2 per 100 GBD problems, advice and counselling about nutrition and weight, counselling about the problem, and advice and education being most common (Table 1).

Table 1. Details of gallbladder disease management
Management typeRate per 100 GBD
problems (n=559)
Medications (all) 42.6
  • Paracetamol/codeine
6.4
  • Hyoscine butylbromide
6.1
Clinical treatments 25.2
  • Counselling/advice – nutrition/weight
9.7
  • Counselling – problem
4.3
  • Advice/education
4.1
Specialist referral 26.8
  • Referral surgeon
22.0
  • Referral gastroenterologist
2.9
Imaging 40.6
  • Ultrasound
37.0
Pathology 64.4
  • Full blood count
15.0
  • Liver function
14.8
  • Electrolytes, urea and creatinine
5.2

Referrals to specialists were frequent, given at a rate of 26.8 per 100 GBD problems: the vast majority (93.0%) being to surgeons (82.0%) and gastroenterologists (10.7%). The referral rate for GBD problems was significantly higher than the BEACH 2011–12 average for all problems (5.6 per 100 problems). Imaging tests were ordered at a rate of 40.6 per 100 GBD problems, substantially higher than the average for all problems (6.6). Ultrasounds accounted for more than 90% of imaging tests ordered. Similarly the order rate of pathology tests (64.4 per 100 GBD problems) was much higher than average (30.6). Full blood count, liver function, and electrolyte, urea and creatinine were the most commonly ordered tests (Table 1).

Competing interests: None.
Provenance and peer review: Commissioned; not peer reviewed.

Acknowledgements

The authors thank the GP participants in BEACH and all members of the BEACH team. Funding contributors to BEACH between January 2010 and December 2012: Abbott Australasia Pty Ltd; Australian Government Department of Health and Ageing; AstraZeneca Pty Ltd (Australia); Bayer Australia Ltd; CSL Biotherapies Pty Ltd; GlaxoSmithKline Australia Pty Ltd; Janssen-Cilag Pty Ltd; Merck Sharp and Dohme (Australia) Pty Ltd; Novartis Pharmaceuticals Australia Pty Ltd; Pfizer Australia; Sanofi-Aventis Australia Pty Ltd; Wyeth Australia Pty Ltd.

References

  1. Mackay S, Dillane P. Biliary pain. Aust Fam Physician 2004;33:977–81.
  2. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 1999;117:632–9.
  3. Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 2005;7:132–40.
  4. Britt H, Miller GC, Henderson J, et al. General practice activity in Australia 2011–12. General practice series no. 31. Sydney: Sydney University Press, 2012.

Correspondence afp@racgp.org.au

Yes     No

Declaration of competing interests *

Yes No

Additional Author (remove)

Yes No

    

 

 

 

 

Competing Interests: 

Your comment is being submitted, please wait

 

Download citation in RIS format (EndNote, Zotero, RefMan, RefWorks)

Download citation in BIBTEX format (RefMan)

Download citation in REFER format (EndNote, Zotero, RefMan, RefWorks)

For more information see Wikipedia: Comparison of reference management software