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Cholelithiasis in Infants: Risk Factors, Management, and the Role of Ursodeoxycholic Acid
Sevim Çakar1, Gülin Eren2, Cahit Barış Erdur2
1Department of Pediatrics, Division of Pediatric Gastroenterology, Faculty of Medicine, Dokuz Eylül University, Izmir 35330, Turkey.
Insights
Infant cholelithiasis is rare. Ursodeoxycholic acid (UDCA) treatment showed limited benefit, with higher resolution rates in non-users, suggesting monitoring may be preferred for asymptomatic cases.
Area of Science:
- Pediatric Gastroenterology
- Neonatology
- Medical Research
Background:
- Cholelithiasis (gallstones) in infants is uncommon, with scarce data on associated risk factors and effective management strategies.
- Understanding these factors is crucial for early diagnosis and intervention in neonates.
Purpose of the Study:
- To investigate the primary risk factors contributing to gallstone formation in infants.
- To evaluate the effectiveness of medical management, specifically Ursodeoxycholic acid (UDCA) therapy, for infant cholelithiasis.
- To assess treatment outcomes and complication rates in this pediatric population.
Main Methods:
- Retrospective analysis of infants diagnosed with cholelithiasis via ultrasound between 2018 and 2023.
- Review of patient demographics, clinical history, imaging results, presenting symptoms, and treatment interventions.
- Comparison of gallstone resolution rates based on UDCA treatment adherence and patient characteristics.
Main Results:
- Ninety-eight infants were diagnosed; common risk factors included cephalosporin use (46.9%), sepsis (30.6%), and prematurity (27.6%).
- Most infants (84.7%) were asymptomatic. Gallstone resolution occurred in 46.9% of cases, with higher spontaneous resolution rates (77.8%) observed in non-UDCA users compared to regular users (40.5%).
- Response to UDCA was poorer in preterm infants. Only four cases of acute cholecystitis were reported, with no surgical interventions required.
Conclusions:
- Routine Ursodeoxycholic acid (UDCA) use in infants with cholelithiasis is not recommended, particularly for asymptomatic cases.
- Clinical monitoring is a viable approach for asymptomatic infants, reserving UDCA for symptomatic cases or those with surgical contraindications.
- Further research is needed to optimize management strategies for pediatric gallstone disease.
Background:
Cholelithiasis is a rare disease in infants, and there is limited data on its risk factors and management.
Objectives:
To evaluate the risk factors, management, and response to medical treatment of cholelithiasis in infants.
Methods:
Infants diagnosed with cholelithiasis by ultrasound between 2018 and 2023 were retrospectively analyzed. Details of patient history, imaging findings, current symptoms, and treatments were reviewed.
Results:
Over 5 years, 98 infants were diagnosed with cholelithiasis. Thirty-three (33.7%) were girls, and the most common risk factors were the use of cephalosporin antibiotic therapy in 46.9%, sepsis in 30.6%, total parenteral nutrition in 29.6%, prematurity in 27.6%, congenital heart disease in 18.4%, and genetic disease (Down syndrome diagnosis in seven patients) in 16.3%. Only fifteen patients (15.3%) were symptomatic. Ursodeoxycholic acid (UDCA) treatment was given to 90.8% of patients, but nine of them used it for a short period or irregularly, and regular users were 81.6%. Gallstones disappeared in 46 patients (46.9%), including 14 (30.4%) without using UDCA regularly. The response rate to UDCA treatment was lower in preterm infants (p = 0.004). Gallstone resolution was higher in the nonusers, 14/18 (77.8%) versus 32/79 (40.5%) (p = 0.03). Acute cholecystitis was observed in only four patients; no other complications were noted. No infant required surgical or endoscopic treatment.
Conclusions:
UDCA should not be used routinely in children, especially infants, except in symptomatic children with a contraindication to surgery or to reduce clinical symptoms. In the absence of symptoms, patients may be monitored clinically.
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