Concerns over rise in gallbladder diseases

*Experts blame illnesses on the proliferation of fast food joints, Western diets
*Advocate high intake of fresh fruits, vegetables, fruit juice, spices, others
*Brainstorm on practice of hepato-pancreato-biliary surgeries in Nigeria

Medical experts have alerted to the rising incidence of gallbladder diseases in Nigeria. The doctors under the aegis of the Nigerian Chapter of European-African Hepato-Pancreato-Biliary Association (E-AHPBA), however, blamed the menace on the proliferation of fast food joints within the last few years.

The surgeons during a two-day surgical congress held at the Surgical Skills Centre/Modular Theatre of the Lagos University Teaching Hospital (LUTH) Idi-Araba, brainstormed on how to treat some of those diseases of the hepatic-pancreato-biliary system especially those that are amenable to surgery.

To prevent hepatic-pancreato-biliary diseases, Medical News Today recommends a high intake of fresh fruits and vegetables, fruit juice, low-fat dairy products, whole grains, nuts, spices, and legumes.

Hepato-pancreato-biliary disease refers to any condition that affects the liver, pancreas, gallbladder, and bile ducts. These diseases commonly share some telltale signs or symptoms, such as jaundice, darker urine colour, and lighter stool colour. While some have genetic or hereditary causes, most are due to chronic damage to the tissues of the organs involved. These conditions are treated and managed by hepatologists, hepato-pancreato-biliary oncologists, and transplant specialists.

The hepato-pancreato-biliary experts from America, South Africa, Norway, and Nigeria include a General Surgeon at LUTH, Dr. Lanre Balogun; Chairman and Academic Head of the Department of Surgery at the University of the Witwatersrand, Johannesburg, South Africa, Prof. Martin Smith; Chief Medical Director (CMD) of LUTH, Prof. Chris Bode; Professor of Paediatrics, University of Calabar, Calabar, Cross River State, Ndoma Egba; Surgical Oncologist, Memorial Sloan Kettering Cancer Center, New York University, United States, Dr. Peter Kingham; and a consultant surgeon at Oslo University Hospital, Norway, Kristoffer Lassen.

The European Hepato-Pancreato-Biliary Association (EHPBA) was founded in 1999 as the European Regional Association of the International Hepato-Pancreato-Biliary Association (IHPBA). The Association then expanded to countries of the Middle East and Africa, thus, forming the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) in 2011. Currently, the Association counts for more than 700 active members from Europe, the Middle East, and Africa.

The gallbladder is a four-inch, pear-shaped organ. It is positioned under the liver in the upper-right section of the abdomen.

The gallbladder stores bile, a combination of fluids, fat, and cholesterol. Bile helps break down fat from food in the intestine. The gallbladder delivers bile into the small intestine. This allows fat-soluble vitamins and nutrients to be more easily absorbed into the bloodstream.

Gallbladder conditions share similar symptoms. These include pain, nausea or vomiting, fever or chills, chronic diarrhea, jaundice, and unusual stools or urine.

Any disease that affects the gallbladder is considered a gallbladder disease. The following conditions are all gallbladder diseases: inflammation of the gallbladder (cholecystitis), gallstones, common bile duct stones (choledocholithiasis), common bile duct infection, gallstone ileus, gallbladder polyps, porcelain gallbladder, and gallbladder cancer.

Balogun told The Guardian: “This is a very rare opportunity that we are making available to local Nigerian surgeons. This meeting is about an association of hepato-biliary surgeons. Hepato-biliary refers to the study of the liver, an organ called pancreas that is the biliary tract, which includes the gall bladder, the liver, and the pancreas. So the three together make hepato-pancreato-biliary system. We have brought experts from America, South Africa, and Norway to come to showcase what they do.

“Surgeries on the liver, pancreas and biliary system are one area where most surgeons are reluctant to operate on. Essentially for the reasons that any slight mistake can lead to fatality and those organs are largely unforgiving. So you need to be specially trained. You need some level of exposure before you can get some dependence to operate on some of those organs, and that is the reason why we are convening this meeting. If you look at the title it is all about enhancing the safe practice of hepato-pancreato-biliary surgery in Nigeria.”

The surgeon said diseases of hepato-pancreato-biliary system range from infectious diseases like hepatitis to cancers and some of them are amenable to surgical treatment.

Balogun said: “Case in question we have in recent times witnessed the rising incidence of gall bladder diseases. So we have quite a number of patients with gall bladder stones presenting to us and most of the time the gold standard of treatment for this is surgery and the surgery is such a very delicate one that it has to be carefully carried out just because these organs by virtue of their location or by virtue of their nature- they are very delicate and a slight mistake can lead to a very morbid consequences.”

Why are most Nigerians suffering from gall bladder disease? He explained: “Just like the previous speaker said, we are witnessing a rising incidence of non-communicable disease. Examples of these are hypertension, diabetes and of course gall stones, in recent, times we have been on the increase by the reason that for the past few years we have seen a rise in the number of fast-food joints. Nigerian diet is changing, we import some of our food products and some of those diseases that we see as rare in our environment are now becoming so common.”

The surgeon, however, said: “But to treat some of those diseases especially those that are amenable to surgery, you need a specialised skill and those specialised skills are not something you can learn at home, you sometimes have to go for training and that is what the experts are actually breaking to us now so that we can improve our standard of care for some of these patients.

“Another important thing I have to mention is that if we have expertise in this, it is also going to limit the amount of medical tourism we have in Nigeria. Case in question, it is only very few centres in the country that are currently offering liver surgery. Liver transplantation is often not being done in any centres in the country at the moment but some of these procedures can be learned with training when you walk with experts, which is actually one of the reasons for convening this meeting.”

How many people are you training and what are their specialties? Balogun said: “We have a total of 28 surgeons attending this meeting. They will be going through some training, some exposure over the next two days. This is just to expose them to the basics principles and to provide the platform for future learning opportunities.”

From what you said, it is like LUTH has plans for liver transplantation in the future? “Definitely we have plans. We are not there yet but it is only one of our plans. At this moment, we are currently offering minimally invasive surgery for wide varieties of conditions, which also includes gallstones diseases. LUTH is actually one of the centres in the country that has the highest number of cases of laparoscopic procedures that have been done in this country,” he said.

Meanwhile, Medical News Today has published diet tips for a healthy gallbladder.

Research suggests that people who follow a healthful diet have a lower risk of gallbladder disease.

Knowing what foods to choose and which ones to avoid may help the gallbladder stay healthy, especially for people who have already experienced gallstones or other gallbladder problems.

There is no specific diet for a healthy gallbladder, but following some guidelines can help keep the gallbladder healthy and functioning well.

According to Medical News Today, a plant-based diet may help keep the gallbladder healthy.

The gallbladder diet aims to help reduce the stress that diet can impose on the gallbladder, either by easing digestion or by supporting the gallbladder.

A 2015 study looked at the dietary habits and risk of gallstones in 114 females. For this study, the researchers broadly described two types of diet:

Healthful diet: A high intake of fresh fruits and vegetables, fruit juice, low-fat dairy products, whole grains, nuts, spices, and legumes.

Unhealthful diet: A high intake of processed meat, soft drinks, refined grains, red meat, high-fat dairy products, sugar, tea, solid fat, baked potato, snacks, egg, salt, pickled food, and sauerkraut.

People who followed a healthful diet pattern overall were less likely to develop gallbladder disease.

A healthful diet will provide a variety of nutrients. A diet that includes a range of plant foods can provide the nutrients the body needs to stay healthy.

Plant-based foods are a good source of vitamins, minerals, and antioxidants. These may help prevent gallbladder disease.

Antioxidants are nutrients that help rid the body of toxic molecules known as free radicals. Free radicals develop in the body as a result of natural processes and environmental stresses, including processed foods. As free radicals build up, oxidative stress can result. This can cause cell damage, which can lead to various diseases, including cancer.

Protein is essential for the repair and growth of body tissues. Red meat and dairy products are good sources of protein, but they can also be high in fat, and high fat intake can put stress on the gallbladder.

Low-fat protein foods are a suitable option. They include poultry, fish, zero fat dairy products, nuts and seeds, soy and soy products, legumes, such as beans and lentils, and dairy alternatives, such as soy milk.

Processed meats and dairy products are often high in added salt. Fresh foods without added sugar are a more healthful option.

A 2016 study found a link between a high intake vegetable protein and a lower risk of gallbladder disease.

Experts say fibre supports digestive health, and it may offer protection from gallbladder disease by enhancing the movement of food through the gut and lowering the production of secondary bile acids.

In 2014, researchers looked at how a high-fiber diet affected the production of biliary sludge during a rapid weight-loss diet for people with obesity. Biliary or gallbladder sludge is a substance that increases the risk of developing gallbladder disease. It can build up in people who fast or lose weight quickly.

Those who followed the high fibre diet accumulated less gallbladder sludge, which reduced their risk of developing gallbladder disease.

This suggests that fibre can help prevent gallbladder disease in people who need to lose weight quickly, and perhaps overall.

Sources of fiber include fruits, vegetables, legumes, nuts and seeds, and whole grains.

According to Medical News Today, unsaturated fats, such as omega-3, may help protect the gallbladder. Sources include cold-water fish, nuts, such as walnuts, seeds, such as flaxseed, and oils from fish or flaxseed.

Moderate coffee consumption may help protect gallbladder function.

Research suggests that substances in coffee may have various benefits for gallbladder function, including balancing certain chemicals and stimulating the action of the gallbladder, and possibly intestinal activity, too.

An adequate intake of calcium in the diet can support gallbladder health. Calcium is present in dark, leafy greens, such as kale and broccoli, dairy foods, such as yogurt, cheese, and milk, fortified dairy alternatives, such as almond or flax milk, sardines, and orange juice.

People with a risk of gallbladder disease should choose zero fat dairy products.

Vitamin C, magnesium, and folate may help prevent gallbladder disease. Fresh fruits and vegetables are good sources of these nutrients.

Vitamin C is available in red and green peppers, oranges and other citrus foods, kiwifruit, broccoli, strawberries, and tomatoes.

Vitamin C is a water-soluble vitamin, which means that cooking in water may remove some of it from the food. Fresh, raw fruits and vegetables are the best sources.

Magnesium is present in almonds and cashews, peanuts and peanut butter, spinach, beans including black beans and edamame, soy milk, potato, avocado, rice, yogurt, and banana.

Good source of folate includes beef liver, spinach, black-eyed peas, fortified cereals, and asparagus.