title: Symptomatic or asymptomatic gallstone disease: is the gallbladder motility the clue?
abstract: OBJECTIVE
  Only a minority of gallstone patients develop biliary pain. Until now, the factors related to pain have been poorly described.
  
  
  METHODS
  In a prospective study, gallstone patients without acute cholecystitis, pancreatitis or hepatobiliary obstruction were classified into typical symptomatic (type-I, n = 44), atypical symptomatic (type-II, n = 14) and asymptomatic (type-III, n = 29) using a standardized questionnaire (8 items for typical, 3 items for unspecific complaints). Demographic data, body mass index, number and size of gallstones, gallbladder wall thickness and motility after a standardized meal were assessed (ultrasound study) in patients, results were compared to controls without hepatobiliary disease.
  
  
  RESULTS
  The gallbladder contractility was similar to controls in type-I (67%) but diminished in II (55%) and III (46%, P < 0.05). Type-I showed lower fasting (P < 0.05) and postprandial gallbladder volumes (P < 0.0005) and was associated with smaller stones (P < 0.0001), younger age (P < 0.0001) and female gender (P < 0.001). Body mass index, stone number and gallbladder wall thickness was not related to pain.
  
  
  CONCLUSIONS
  A sluggish gallbladder may protect from biliary pain. The consideration of gallbladder motility and further risk factors (small stones, younger age and female gender) may help to predict the clinical course of gallstone patients, define atypical complaints as biliary related and select patients for treatment.
authors.affiliation: Department of Internal Medicine I, Division of Gastroenterology, Medical University of Luebeck, Lubeck, Germany. brand@uke.uni-hamburg.de
authors.forename: Boris
authors.initials: B
authors.lastname: Brand
authors.forename: Lutz
authors.initials: L
authors.lastname: Lerche
authors.forename: Eduard F
authors.initials: EF
authors.lastname: Stange
mesh_terms: D000328:Adult; D002769:Cholelithiasis / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D005704:Gallbladder / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies