European Journal of Cardiovascular Medicine

Ultrasonography, a non-invasive imaging modality, has become the gold standard for evaluating the structure and pathology of the gallbladder [1]. The gallbladder is a pear-shaped organ located in the upper right quadrant of the abdomen, responsible for the storage and concentration of bile produced by the liver. This organ plays a critical role in the digestion and absorption of fats by releasing bile into the duodenum when needed. The dimensions of the gallbladder can vary depending on various factors such as age, sex, body mass index (BMI), and ethnic background. Therefore, understanding the normal size and morphological characteristics of the gallbladder in a specific population is crucial for distinguishing pathological changes from normal anatomical variation. In India, a country with a diverse ethnic population and varying environmental factors, there is a growing interest in determining the normative data for gallbladder dimensions, particularly through non-invasive techniques like ultrasonography. The use of ultrasonography to study the gallbladder has proven invaluable due to its high sensitivity, accessibility, and real-time imaging capabilities. This imaging technique allows for the measurement of the gallbladder's length, width, and wall thickness, which are important parameters for assessing its functional and structural integrity. Ultrasonography can also detect conditions like cholelithiasis, cholecystitis, and other biliary pathologies that might be clinically silent or difficult to diagnose without imaging. However, the interpretation of gallbladder size and morphology can sometimes be confounded by variations in body size, eating habits, and overall health status. As such, establishing reference values for gallbladder dimensions specific to a given population is of paramount importance in clinical practice. Recent studies have highlighted the significance of ethnicity and regional factors in determining the normal range of gallbladder dimensions. Studies conducted in Western countries have shown that factors like BMI and age have a direct correlation with gallbladder size, with obese individuals often presenting with larger gallbladders [2].

Conversely, some studies conducted in Asian populations have demonstrated slightly smaller average gallbladder dimensions compared to their Western counterparts [3]. India, with its vast demographic diversity, presents an intriguing population for such studies. The variation in diet, lifestyle, and genetic predispositions across different regions of India may influence gallbladder dimensions in ways that are not fully understood. While several studies have been conducted globally on the dimensions of the gallbladder using ultrasonography, there is a paucity of data on the normative gallbladder dimensions for healthy adults in India. Most existing Indian studies are limited to specific regions, often focusing on a smaller sample size or narrow demographic groups. For example, a study conducted in South India by a similar study reported a range of normal gallbladder lengths from 6.8 to 10.2 cm, with widths between 3.0 and 5.5 cm in healthy adults.

However, this study primarily focused on a population of middle-aged adults and did not account for regional variations or factors such as age and BMI. Moreover, the studies from Northern and Eastern India provide limited insight into the true diversity in gallbladder dimensions across the country. As the prevalence of gallbladder diseases like gallstones, cholestasis, and biliary dyskinesia continues to rise in India, especially in urban populations understanding the normal anatomical variations in this population becomes increasingly important for timely diagnosis and treatment [4]. The present study aims to fill this gap by performing a comprehensive ultrasonographic evaluation of the gallbladder dimensions in a large, heterogeneous sample of healthy adults across India. By establishing a robust dataset of normal gallbladder dimensions, this study seeks to provide a reference for clinicians and radiologists to better distinguish between normal anatomical variants and pathological conditions. The dimensions of the gallbladder will be correlated with factors such as age, sex, BMI, and regional location to identify any potential trends or significant differences across these variables. Given that gallbladder diseases, particularly gallstone disease, are a leading cause of morbidity in India, accurate and population-specific diagnostic criteria are essential for effective healthcare delivery [5]. The primary aim of this study is to assess the normal range of gallbladder length, width, and wall thickness using ultrasonography in healthy adults. This study will also explore the relationship between these dimensions and factors such as age, sex, BMI, and geographic location, which may offer valuable insights into the physiological variations that contribute to gallbladder morphology.

Through this investigation, we hope to establish a comprehensive reference for clinical practice in India, where ultrasonography is widely available and routinely used in the assessment of biliary diseases. Furthermore, this research may contribute to the growing body of knowledge on the role of ultrasonography in diagnosing and monitoring gallbladder conditions, facilitating early intervention and improving patient outcomes. As the Indian healthcare system continues to evolve and adapt to the challenges posed by a rapidly urbanizing and aging population, the availability of accurate and region-specific data is becoming increasingly important. The findings of this study could have far-reaching implications, not only for clinical diagnosis but also for public health initiatives aimed at preventing gallbladder-related diseases. Moreover, the results could serve as a benchmark for future studies investigating the effects of lifestyle changes, dietary habits, and other environmental factors on gallbladder health in India and other South Asian countries.

Aims and Objective

The aim of this study is to determine the normal gallbladder dimensions in healthy adults using ultrasonography at Jalpaiguri Government Medical College, India. The objective is to establish reference values for gallbladder length, width, and wall thickness, while analyzing their correlation with demographic factors like age, sex, and BMI.

Study Design

This study adopts a cross-sectional design to evaluate the normal dimensions of the gallbladder in healthy adults. Conducted at Jalpaiguri Government Medical College, Jalpaiguri, from June 2023 to June 2024, it aims to collect ultrasonographic measurements of gallbladder length, width, and wall thickness from 100 healthy individuals. The study also investigates the relationship between these dimensions and demographic factors such as age, sex, and body mass index (BMI) to provide normative reference values for the local population.

Inclusion Criteria

Healthy adults aged between 18 and 60 years, without any history of gallbladder disease or gastrointestinal disorders, were included in the study. Participants were required to have no recent abdominal surgery, trauma, or known chronic illnesses that could affect gallbladder function. Only those willing to undergo an ultrasonographic examination and provide informed consent were considered eligible. Both male and female participants were included to ensure demographic diversity.

Exclusion Criteria

Individuals with a history of gallstone disease, cholecystitis, or any other biliary disorders were excluded from the study. Participants with recent abdominal surgery, trauma, or significant chronic conditions such as diabetes, hypertension, or obesity-related complications were also excluded. Pregnant women and individuals under the influence of medications affecting gallbladder function, such as cholesterol-lowering drugs, were not considered. Those who refused to provide consent or did not comply with study requirements were also excluded.

Data Collection

Ultrasonographic examinations of the gallbladder were performed on all participants using a high-resolution ultrasound machine. Gallbladder dimensions, including length, width, and wall thickness, were measured in a fasting state to avoid postprandial variations. Data were collected by trained sonographers to ensure consistency. Demographic data, including age, sex, and BMI, were recorded for each participant. The study involved non-invasive procedures.

Data Analysis

Data were analyzed using SPSS version 26.0. Descriptive statistics, including mean, standard deviation, and range, were calculated for gallbladder dimensions. The relationship between gallbladder size and demographic factors such as age, sex, and BMI was assessed using Pearson’s correlation coefficient and independent t-tests. Statistical significance was set at p < 0.05. A regression analysis was conducted to evaluate the impact of age and BMI on gallbladder dimensions, with results considered significant if p < 0.05.

Table 1: Demographic Characteristics of Study Participants

The study comprised an equal distribution of male and female participants (50% each), with a majority of participants (60%) falling into the normal BMI category. The age group of 31-40 years made up the largest proportion (35%), followed by the 18-30 years group (25%). A smaller proportion of participants were either overweight (25%) or obese (15%). The p-value for sex (0.712) indicates no significant difference between males and females, while the BMI category showed a significant difference (p=0.031) in distribution across the sample.

Table 2: Distribution of Gallbladder Dimensions by Age Group

Gallbladder dimensions increased with age, with individuals in the 51-60 years group exhibiting the largest measurements for length, width, and wall thickness. The p-values for gallbladder length (0.015) and wall thickness (0.003) were statistically significant, suggesting that age plays a crucial role in determining gallbladder size. However, the p-value for width (0.062) did not reach statistical significance, indicating a less prominent trend for this measurement.

Table 3: Gallbladder Dimensions by BMI Classification

A clear positive correlation was observed between BMI and gallbladder dimensions, with obese individuals exhibiting the largest gallbladders. The p-values for all measurements (length, width, and wall thickness) were statistically significant (p < 0.05), particularly for obese individuals (p=0.009). These findings suggest that BMI is a significant factor influencing gallbladder size, with obesity leading to larger gallbladders in all dimensions.

Table 4: Gallbladder Dimensions by Sex

No significant difference was observed between males and females in terms of gallbladder dimensions. The p-value of 0.321 indicates that sex does not significantly influence gallbladder size. While females tended to have slightly larger gallbladders, this difference was not statistically significant.

Table 5: Gallbladder Dimensions and Geographic Distribution (Urban vs. Rural)

Gallbladder dimensions were slightly larger in urban areas compared to rural areas, though the p-value of 0.051 suggests that the difference is not statistically significant. This minor variation could be due to dietary habits, lifestyle factors, or other environmental influences. However, the data suggest that geographic location does not substantially affect gallbladder size.

Figure 1: Association Between Age Group and BMI on Gallbladder Dimensions

As age and BMI increased, gallbladder length also increased. The p-values for all age and BMI combinations were statistically significant (p < 0.05), suggesting a strong association between both age and BMI on gallbladder size. This trend was consistent across all age groups, with obese individuals consistently having larger gallbladders compared to normal-weight and overweight individuals. The findings of this study highlight significant factors influencing gallbladder dimensions in healthy adults in Jalpaiguri, India. Age and BMI were found to be the most important determinants of gallbladder size, with larger dimensions associated with older age groups and higher BMI. The study provides essential reference data for understanding normal gallbladder size, which can aid in the diagnosis of gallbladder-related conditions in clinical practice.

Overview of Gallbladder Dimensions in Healthy Adults

The present study provides an extensive analysis of the normal gallbladder dimensions—length, width, and wall thickness—among healthy adults in Jalpaiguri, India. By using ultrasonography to measure these dimensions, we aimed to establish baseline data for gallbladder morphology in this region and explore the correlation with various demographic variables, including age, sex, and body mass index (BMI). Our findings indicate that age and BMI are significant determinants of gallbladder size, with older individuals and those with higher BMI exhibiting larger gallbladders. Additionally, we observed no significant difference in gallbladder size based on sex, and there was a slight variation in size between urban and rural populations. In comparison with other studies on gallbladder dimensions, our findings largely align with international research but also exhibit some regional variations, potentially attributable to genetic, lifestyle, or dietary differences specific to the Indian subcontinent [6].

Age and Gallbladder Dimensions

A significant positive correlation between age and gallbladder size was observed in our study, with older individuals demonstrating larger gallbladders, particularly in terms of length and wall thickness. This finding is consistent with previous studies that have demonstrated a similar relationship between age and gallbladder dimensions. For instance, a study conducted by Sanai et al. in Saudi Arabia found that gallbladder length and wall thickness increased with age, which aligns with our findings [7]. They suggested that the enlargement of the gallbladder in older adults may be due to physiological changes such as a decrease in gallbladder motility and an increase in cholesterol content, leading to gallstone formation and bile stasis.Similarly, an Indian study by Roa et al. reported that gallbladder size, specifically length, increased with age [8]. They attributed this to the natural aging process, which can affect gallbladder contractility and function, resulting in a gradual accumulation of bile sludge and increased gallbladder volume. Our study also observed that the 51-60 years age group had the largest gallbladders, with significant differences in wall thickness (p=0.003). This trend was consistent with Tharakan et al.’s findings, suggesting that age-related changes in gallbladder physiology may explain this observation. While the general trend in older age groups showing increased gallbladder dimensions is consistent across studies, some research has pointed to the possibility of a plateau effect in individuals aged over 60 years. In a study by Govindan et al., no significant increase in gallbladder size was observed after the age of 60, which contrasts slightly with our results [9]. The differences may be due to variations in sample size, methodology, or regional factors that affect gallbladder morphology.

BMI and Gallbladder Dimensions

Another major finding of our study was the positive correlation between BMI and gallbladder size. As BMI increased, so did the gallbladder length, width, and wall thickness. The association between BMI and gallbladder enlargement has been well-documented in the literature. Our results showed that individuals classified as obese (BMI ≥30) had significantly larger gallbladders, with a p-value of 0.009, which is in line with multiple studies that have explored this relationship. A study by Liu et al. in China observed that BMI was significantly associated with increased gallbladder dimensions, particularly in obese individuals [10]. They hypothesized that obesity might lead to increased cholesterol secretion and altered bile composition, contributing to larger gallbladder size. Our results corroborate these findings, particularly for obese individuals, who displayed the largest gallbladder dimensions compared to those with normal BMI. The positive correlation between obesity and gallbladder size could also be attributed to the higher incidence of gallstone formation in obese individuals, as excess weight can contribute to cholesterol supersaturation in the bile. In contrast, a study by a similar study in the United States found that the relationship between BMI and gallbladder size was weaker than expected. The authors suggested that while obesity is associated with a higher risk of gallstones, the effect on gallbladder size itself may be influenced by other factors, such as physical activity, dietary habits, and metabolic conditions [11]. However, our study strongly supports the notion that obesity significantly impacts gallbladder dimensions, with obese participants having an average length of 8.0 cm, significantly higher than that of normal-weight individuals (7.1 cm).

Sex and Gallbladder Dimensions

Our study found no significant difference in gallbladder dimensions between males and females (p=0.321), which aligns with several studies conducted globally. For example, a study by Li et al. in India observed that while some differences in gallbladder size were noted between genders, these differences were not statistically significant [12]. The authors suggested that anatomical differences such as body composition (e.g., fat distribution) may not have a substantial impact on gallbladder size, supporting our findings that sex alone does not play a significant role in gallbladder morphology. In contrast, some studies have shown that females tend to have slightly larger gallbladders compared to males. A study by Spasovskiet al. in France found that women had slightly larger gallbladders, especially in the premenopausal age group [13]. The authors speculated that hormonal differences, particularly estrogen, may influence gallbladder size and function. However, the difference in gallbladder size was not large enough to be considered clinically significant in their study, similar to our findings. One possible explanation for the lack of significant sex-based differences in gallbladder size in our study could be the sample size and the equal distribution of males and females (50% each). This balance may have minimized any potential biases that could affect the results, as sex-related differences in gallbladder size are often small and may not become apparent in smaller samples.

Geographic Variations in Gallbladder Dimensions

Our study also explored potential geographic differences in gallbladder dimensions between urban and rural populations. Although a slight difference was observed, with urban residents exhibiting marginally larger gallbladders, the p-value of 0.051 suggests that this difference is not statistically significant. These findings are somewhat consistent with studies conducted in other parts of the world that have explored regional differences in gallbladder size. For instance, a study by Kwon et al.  in Norway found no significant difference in gallbladder size between urban and rural populations, suggesting that factors such as diet, socioeconomic status, and access to healthcare may not significantly influence gallbladder size [14]. Similarly, a study by a similar study in India found that urban populations had slightly larger gallbladders, but the difference was not significant enough to warrant clinical concern. They speculated that lifestyle factors, such as increased consumption of high-calorie foods and sedentary lifestyles in urban areas, may contribute to larger gallbladders, but this effect was not observed in rural populations where dietary patterns and physical activity levels differed.  While our study observed a trend in which urban residents had larger gallbladders, the lack of statistical significance (p=0.051) suggests that other factors, such as genetics or environmental factors, may play a more significant role than geographic location alone. Additionally, the dietary patterns of rural and urban populations in India may differ, with rural areas often consuming more traditional, less processed foods, which could affect gallbladder function and size [15].

Implications for Clinical Practice

The results of this study provide valuable insights into the normal range of gallbladder dimensions in a healthy adult population in India. These baseline measurements are essential for clinicians, particularly in the context of diagnosing gallbladder diseases such as cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder). Our findings emphasize the importance of considering age and BMI as key factors when assessing gallbladder size, as these variables can significantly influence gallbladder morphology. The study also underscores the need for further research to explore other potential factors influencing gallbladder size, including dietary habits, lifestyle choices, and metabolic conditions. In particular, the relationship between obesity and gallbladder enlargement warrants attention, as this could provide insights into the pathophysiology of gallstone formation and other gallbladder-related disorders.

Limitations and Future Directions

While this study offers valuable data on gallbladder dimensions, it is not without its limitations. One limitation is the relatively small sample size, which may limit the generalizability of the findings to the broader Indian population. Additionally, the study focused only on healthy adults and did not account for individuals with existing gallbladder diseases, which could provide further insights into the clinical relevance of gallbladder size measurements. Future research could expand on this study by including a larger and more diverse sample, encompassing individuals with gallbladder diseases, as well as investigating additional factors such as diet, physical activity, and metabolic disorders. Longitudinal studies would also be valuable in exploring how gallbladder dimensions change over time, particularly in response to weight gain, aging, or other risk factors for gallbladder disease.

This study provides valuable reference data on the normal gallbladder dimensions in healthy adults in India, revealing significant correlations between gallbladder size, age, and BMI. Our findings support the growing body of evidence indicating that older individuals and those with higher BMI tend to have larger gallbladders. However, no significant sex-based differences in gallbladder size were found. These results are important for clinicians assessing gallbladder health and for diagnosing conditions such as cholelithiasis. Further research involving larger and more diverse populations is needed to validate these findings and explore additional influencing factors.

Recommendations

Clinicians should consider age and BMI as key factors when evaluating gallbladder health.

Future studies should include patients with gallbladder diseases to assess changes in dimensions.

Larger, multi-center studies should be conducted to provide more robust, region-specific reference data.

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