The present study confirmed this finding, since three of the four adolescents

with lithiasis were female. Several studies have shown a higher frequency of cholelithiasis in the female gender.8 and 22 The female gender is associated with cholelithiasis, especially during the childbearing years. Estrogens increase the secretion of cholesterol and decrease the secretion of bile salts, whereas progestogens act by reducing the secretion of bile salts and the emptying of the gallbladder, leading to stasis.24 The frequency of hepatic steatosis (21.2%) was lower than that reported by Lira et al.,25 who observed it in 27.7% of the 172 adolescents, and greater than that reported by Schwimmer et al.,26 who reported it in 9.6% among children and adolescents. These authors reported that the prevalence increases with age, ranging from 0.7% from ages 2 to 4 years to 17.3% from ages 15 to 19 years.7 In the present study, the significant find more association between cholelithiasis and hepatic steatosis is spurious, since obesity is implicated as a risk factor for both.16 and 22 Regarding the physiopathology,

cholelithiasis and hepatic steatosis behave as independent variables.19 The presence of symptoms associated with cholelithiasis in this study was greater than that reported in the literature, as all four patients were symptomatic; however, only intolerance to dietary fat was significant. Ruibal et al.27 studied 123 children and adolescents with cholelithiasis and observed that 66% had symptoms; approximately 35% had abdominal pain associated with vomiting and 27% had isolated abdominal Cilengitide cell line pain. Wesdorp et al.11 studied the clinical presentation of 82 children and adolescents with cholelithiasis, most with hemolytic disease (32/82) and only three with obesity, and observed that 17% were asymptomatic,

52% had biliary symptoms (biliary colic and jaundice), 24% had unspecific abdominal pain, and 7% had acute abdominal pain with fever. Among patients with biliary symptoms, 10% reported intolerance to fat. However, certain vague complaints such as symptoms of dyspepsia with certain foods, flatulence, nausea, and bloating that have been in the past attributed to cholelithiasis are not accepted today, mainly because of lack of improvement LY294002 after cholecystectomy, and are thus attributed to irritable bowel syndrome or other organic or functional diseases.16 The findings in the present study suggest that the symptomatic clinical picture is more often observed in obese adolescents. However, further studies with larger samples are needed in order to identify the most relevant symptoms. The greater weight loss in cholelithiasis patients shown in the present study is consistent with the literature. Kaechele et al.20 observed that obese children and adolescents with cholelithiasis lost an average of 10.1 ± 7.0 kg compared with only 5.8 ± 5.0 kg lost in the group without cholelithiasis.