Gallbladder Stone Disease Is Associated with an Increased Risk of Migraines

Pain from Internal Organs and Headache: The Challenge of Comorbidity

Headache and visceral pain are common clinical painful conditions, which often co-exist in the same patients. Numbers relative to their co-occurrence suggest possible common pathophysiological mechanisms. The aim of the present narrative review is to describe the most frequent headache and visceral pain associations and to discuss the possible underlying mechanisms of the associations and their diagnostic and therapeutic implications based on the most recent evidence from the international literature. The conditions addressed are as follows: visceral pain from the cardiovascular, gastrointestinal, and urogenital areas and primary headache conditions such as migraine and tension-type headache. The most frequent comorbidities involve the following: cardiac ischemic pain and migraine (possible shared mechanism of endothelial dysfunction, oxidative stress, and genetic and hormonal factors), functional gastrointestinal disorders, particularly IBS and both migraine and tension-type headache, primary or secondary dysmenorrhea and migraine, and painful bladder syndrome and headache (possible shared mechanisms of peripheral and central sensitization processes). The data also show that the various visceral pain-headache associations are characterized by more than a simple sum of symptoms from each condition but often involve complex interactions with the frequent enhancement of symptoms from both, which is crucial for diagnostic and treatment purposes.

Personality differences in patients with and without gallstones

OBJECTIVE

Presence of gallstones is associated with a range of risk factors that have previously shown associations with personality traits. Our aim was to assess the differences in personality traits between the patients with and without gallstones.

METHODS

This study used a case-control design with 308 participants from the general population, 68.2% female, mean age 49.2 (SD 9.24) years, of whom 154 (50%) participants had asymptomatic gallstones. Personality was assessed with the Temperament and Character Inventory - Revised - 140 (TCI-R-140) and depression with the Center for Epidemiological Study of Depression Scale (CESD). Cut-off ≥16 on the CES-D was used as an exclusion criterion. Subjects were also checked for metabolic risk factors and sociodemographic characteristics.

RESULTS

The group with gallstones had significantly more pronounced metabolic risk factors and higher prevalence of smoking and alcohol usage in comparison with the group without gallstones. This group also exhibited higher temperament dimension Harm avoidance (HA) and lower character dimension Self-directedness (SD). Metabolic variables differed based on character dimension Cooperativeness (CO), smoking based on temperament dimensions Novelty seeking (NS) and HA, and alcohol usage on dimension NS within the gallstones group. In the logistic regression, controlled for smoking, alcohol usage and metabolic variables, temperament dimension HA was shown to be a significant predictor of the presence of gallstones.

CONCLUSION

Our findings indicate that personality may be associated with the presence of gallstones. Future longitudinal studies addressing the complex interplay of personality traits, psychological mechanisms and the associated behavioral, metabolic and neurobiological factors, are needed.

Risk of aortic dissection or aneurysm in patients with gallstone disease: a retrospective cohort study in Taiwan

OBJECTIVE

This nationwide population-based cohort study was to compare the risk of aortic dissection (AD) or aortic aneurysm (AN) between the subjects with and without gallstone disease (GD). We also compare the risk of AD/AN between the patients with GD with and without cholecystectomy.

SETTING

This nationwide population-based cohort study.

PARTICIPANTS

We extracted the hospitalisation database from the National Health Insurance Research Database of Taiwan and identified a total of 343 300 patients aged ≥20 years with GD newly diagnosed between 2000 and 2010 as the study cohort, including 191 111 with cholecystectomy and 152 189 without cholecystectomy, respectively. We randomly selected those without GD as the control cohort, by 1:1 propensity score matching with the study cohort based on age, sex, comorbidities and year of the index date for GD diagnosis.

RESULTS

The incidence of AD/AN was 6.65/10 000 person-years for the GD cohort and 6.24/10 000 person-years for the non-GD cohort (adjusted HR (aHR)=1.11, 95% CI=1.09 to 1.13), respectively (p<0.001). Furthermore, the incidence of AD/AN in the patients with GD was 9.93/10 000 person-years for the non-cholecystectomy patients (aHR=1.24, 95% CI=1.22 to 1.26) and 4.63/10 000 person-years for the cholecystectomy patients (aHR=0.97, 95% CI=0.95 to 0.99), respectively (p<0.05).

CONCLUSIONS

The GD cohort was associated with and greater risk of AD/AN than the non-GD cohort, but the risk of AD/AN in the patients with GD would decrease after cholecystectomy.

The Effectiveness of Scutellaria baicalensis on Migraine: Implications from Clinical Use and Experimental Proof

Background

Scutellaria baicalensis (SB), a traditional Chinese medicine, is commonly used for the treatment of inflammatory and painful conditions. The purpose of the present study was to examine the effects of SB on migraine.

Materials and Methods

We examined the clinical applications of SB based on the data obtained from Taiwan's National Health Insurance Research Database and confirmed that it was frequently used in Taiwan for the treatment of headaches. An experimental migraine model was established in rats by an intraperitoneal injection of nitroglycerin (NTG, 10 mg/kg). Pretreatment with SB was given orally 30 min before NTG administration. The rats were subjected to migraine-related behaviour tests that were video-recorded and analysed using EthoVision XT 12.0 software.

Results

The frequency of exploratory and locomotor behaviour was comparatively lower in the NTG group than that in the control group, while the frequency of resting and grooming behaviour increased. These phenomena were ameliorated by pretreatment with 1.0 g/kg SB. The total time spent on the smooth surface was longer in the NTG group than that in the control group, but the time was shortened by pretreatment with 1.0 g/kg SB.

Conclusions

Pretreatment with 1.0 g/kg SB relieved migraine-related behaviours in the experimental NTG-induced migraine model. The outcome therefore demonstrated that pretreatment with 1.0 g/kg SB is beneficial for migraine treatment.

The association between gallstone disease (GSD) and hip fracture: a nationwide population-based study

Objectives: Despite the high prevalence of gallstone disease (GSD), the shared risk factors of GSD and osteoporosis, and the known association between hip fracture and hepatobiliary diseases, the association between hip fracture and GSD is not currently clear. Therefore, we performed a nationwide population-based study to investigate the association between GSD and hip fracture to determine the impact of cholecystectomy on the risk of fracture.Methods: In this study, we assessed all subjects in the longitudinal health insurance database (LHID) between 2000 and 2011, excluding those subjects aged >20 years old and those with a previous history of hip fracture (ICD-9-CM 820). Among those that were included, subjects with at least two or more outpatient visits or with one record of hospitalization under the coding of GSD (ICD-9-CM code: 574) were allocated to the GSD cohort. The remaining subjects were designated to the control cohort. All participants were followed till the onset of hip fracture, withdrawal from the NHI, or the end of 2013.Results: We found that the cumulative incidence of hip fracture was higher in the GSD cohort than in the control cohort (log-rank test: p-value < 0.01). After adjustment, the GSD patients had a 1.21-fold risk of hip fracture compared to control subjects (aHR = 1.21, 95% CI = 1.21-1.30). Comparison between those subjects without GSD and those without cholecystectomy revealed that the risk of hip fracture was higher among GSD patients that had not undergone cholecystectomy (aHR = 1.17, 95% CI = 1.06-1.29) or those that had undergone cholecystectomy (aHR = 1.22, 95% CI = 1.06-1.41).Conclusion: Based upon these results, we concluded that GSD was associated with an increased risk of hip fracture regardless of whether the patient had undergone cholecystectomy.

The effect of cholecystectomy on the risk of acute myocardial infarction in patients with gallbladder stones

Objectives: To investigate the effect of cholecystectomy on the subsequent risk of acute myocardial infarction (AMI) in patients with gallbladder stones (GBS).Methods: We used the Taiwan National Health Insurance Research Database (NHIRD) for hospitalization to conduct a retrospective nationwide population-based cohort study. The study cohort consisted of a total of 122,421 patients aged ≥20 years with cholecystectomy for GBS between 2000 and 2010. The control cohort consisted of the GBS patients without cholecystectomy and they were randomly selected by propensity score matching with the study cohort at a 1:1 ratio according to age, sex, occupation category, urbanization level, comorbidities, and year of the index date for cholecystectomy. We measured the incidence of AMI for both cohorts.Results: The cumulative incidence of AMI was lower in GB patients with cholecystectomy than that in those without cholecystectomy (2.26 vs 3.28 per 1000 person-years, adjusted hazard ratio [aHR] = 0.65, 95% confidence interval [CI] = 0.61-0.69). Compared to those without cholecystectomy, the risk of developing AMI after cholecystectomy was 0.69 (95% CI = 0.63-0.76) for the first year, 0.69 (95% CI = 0.63-0.77) for 2-5 years, and 0.59 (95% CI = 0.53-0.66) for ≥5 years, respectively.Conclusions: Our findings indicate cholecystectomy ameliorates the risk of AMI in patients with GBS, and the protective effect tends to increase with incremental duration of follow-up. However, it needs more studies to ascertain the protective mechanisms of cholecystectomy against AMI.