Cholelithiasis prevalence and risk factors in individuals with severe or profound intellectual and motor disabilities.
Silent gallstones hit 1 in 4 ventilator- or tube-fed adults with profound ID—watch for GI cues and request imaging.
01Research in Context
What this study did
Doctors looked at the adults with severe or profound intellectual and motor disabilities. All lived in large care homes.
Each person had an ultrasound of the belly. The team also checked who used a feeding tube or a ventilator.
What they found
One in four people (27 %) already had gallstones. Most had no pain.
Tube feeding raised the risk 10-fold. Ventilator use raised it 20-fold. Age and sex did not matter.
How this fits with other research
Morad et al. (2007) counted constipation in the same setting and also found high silent illness.
Moss et al. (2009) saw 17 % hypertension in Dutch adults with ID. Gallstones are now even more common.
All three studies show hidden medical problems in people who cannot speak. The numbers differ because each looked at a different body system.
Why it matters
If your client uses a G-tube or ventilator, add "gallstone check" to your GI data sheet. Note new grimacing, vomiting, or food refusal. Ask the nurse for an ultrasound instead of just treating "behavior." Catching stones early prevents emergency surgery and keeps the person in your program.
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02At a glance
03Original abstract
BACKGROUND: The prevalence and risk factors of cholelithiasis in individuals with severe or profound intellectual and motor disabilities (SPIMD) are poorly characterised. Thus, we aimed to investigate the prevalence and risk determinants of cholelithiasis in a cohort with SPIMD under medical care in a residential facility. METHODS: We categorised 84 patients in a residential hospital for persons with SPIMD into groups: those with (Group CL) and without (Group N) cholelithiasis. Gallstones were detected via computed tomography, ultrasonography or both. We evaluated gastrostomy status, nutritional and respiratory support, constipation, and bladder and kidney stones. Data were significantly analysed using univariate and multivariate logistic regression analyses. RESULTS: The prevalence rate of cholelithiasis in our SPIMD cohort was 27%. There were no significant differences in sex, age, weight, height, or Gross Motor Function Classification System between the two groups. However, more patients received enteral nutrition (39.13% vs. 6.56%; P = 0.000751) and were on ventilator support (56.52% vs. 19.67%; P = 0.00249) in Group CL than in Group N. Enteral nutrition [odds ratio (OR) 10.4, 95% confidence interval (CI) 1.98-54.7] and ventilator support (OR 20.0, 95% CI 1.99-201.0) were identified as independent risk factors for the prevalence of cholelithiasis in patients with SPIMD. CONCLUSIONS: Patients with SPIMD demonstrated an increased prevalence of cholelithiasis, with a notable association between nutritional tonic use and respiratory support. Therefore, to emphasise the need for proactive screening, it is crucial to devise diagnostic and therapeutic strategies specific to patients with SPIMD. Further investigation is essential to validate our findings and explore causative factors.
Journal of intellectual disability research : JIDR, 2024 · doi:10.1111/jir.13113