Epidemiological and clinical aspects of non-acute gallstone disease

BACKGROUND Gallstones are common in many countries, but few patients develop severe complications. Fatal complications are rare and affect chiefly the very old. Gallstones may be an aetiological factor for gallbladder cancer, which has a poor prognosis but seldom occurs in young people. The risk of developing gallbladder cancer is small.The standard treatment for gallstone disease has been and still is cholecystectomy. Significant variations in cholecystectomy rates between different areas imply varying indications for gallstone surgery. Too little is known about the prognosis of non-acute gallstone disease to establish solid indications for cholecystectomy in these patients. Further studies on non-acute gallstone disease are therefore warranted.AIMS OF THE STUDYTo analyse changes in the age- and sex-specific frequency and outcome of operation for gallstone disease over a 10-year period (I). To study anamnestic data and frequency of gallstones in people referred for oral cholecystography and to assess the number ofdays of sick leave and in-patient care during a 4 year period in patients referred for oral cholecystography (II,III). To study the physical and biochemical findings in patients with gallstones diagnosed by oral cholecystography and to study the prevalence of gallstones in patients with diabetes mellitus (IV,V). To study the outcome of expectant management of gallstone disease diagnosed by oral cholecystography and to analyse the risk factors for recurrent gallstone symptoms and complications (VI).RESULTSThe reduction in the cholecystectomy rate observed in Sweden during the 1970s is to a large extent accounted for by a decline in the number of elective operations. Introduction of the endoscopic technique for treatment of bile duct stones has only to a limited extent changed the cholecystectomy rate. Gallstone surgery is today often performed on older patients as an acute procedure, yet this is associated with low postoperative morbidity and mortality.Patients referred for oral cholecystography often have other diseases and they present unspecific symptoms. This is reflected in increased sick leave during the years following cholecystography. Gallstone disease is responsible for only a small part of this sick leave.Gallstones diagnosed by oral cholecystography are associated with obesity and short stature in women, and high serum triglyceride and low cholesterol concentrations in both sexes.In patients with well controlled insulin dependent diabetes mellitus the risk of developing gallstones is not increased. In patients with gallstones diagnosed by oral cholecystography the prognosis with regard to the gallstone disease is generally good. However, the occurrence of a gallstone complication is a strong indication for cholecystectomy. In patients with uncomplicated gallstone disease and infrequent gallstone symptoms expectant management is advisable.