Risk factors for the development of gallstone recurrence following medical dissolution. The British-Italian Gallstone Study Group.
OBJECTIVE
To assess risk factors for gallstone recurrence following non-surgical treatment.


METHODS
A prospective follow-up of a multicentre cohort of post-dissolution gallstone patients.


METHODS
Six gastroenterology units in the UK and Italy.


METHODS
One hundred and sixty-three patients with confirmed gallstone dissolution following non-surgical therapy (bile acids or lithotripsy plus bile acids), followed up by ultrasound scan and clinical assessment at 6-monthly intervals for up to 6 years (median, 25 months; range, 6-70 months).


METHODS
Subject-related variables (sex, age, height, weight, body mass index), gallstone-related variables (number, diameter, presence of symptoms, months to complete stone clearance), treatment modalities (bile acid therapy, extracorporeal shock wave lithotripsy) and follow-up related variables (weight change, use of non-steroidal anti-inflammatory agents, statins, pregnancies and/or use of oestrogens) were assessed by univariate and multivariate analysis as putative risk factors for gallstone recurrence.


RESULTS
Forty-five gallstone recurrences were observed during the follow-up period. Multiple primary gallstones and length of time to achieve gallstone dissolution were the only variables associated with a significant increase in the recurrence rate. Appearance of biliary sludge during follow-up was also significantly related to development of gallstone recurrence. Use of statins or non-steroidal anti-inflammatory agents did not confer protection against recurrence.


CONCLUSIONS
Patients with primary single stones are the best candidates for non-surgical treatment of gallstones, because of a low risk of gallstone recurrence. The positive association of recurrence with biliary sludge formation and time to dissolution of primary stones may provide indirect confirmation for the role of impaired gallbladder motility in the pathogenesis of this condition.
St George's Hospital Medical School, London, UK.
M L
ML
Petroni
R P
RP
Jazrawi
P
P
Pazzi
M
M
Zuin
A
A
Lanzini
M
M
Fracchia
D
D
Facchinetti
V
V
Alvisi
R
R
Ferraris
J M
JM
Bland
K W
KW
Heaton
M
M
Podda
T C
TC
Northfield
D000293:Adolescent; D000328:Adult; D000368:Aged; D002635:Chenodeoxycholic Acid / Q000627:therapeutic use; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002769:Cholelithiasis / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D002756:Cholagogues and Choleretics; D002635:Chenodeoxycholic Acid; D014580:Ursodeoxycholic Acid