Gallstone disease: Primary and secondary prevention.
Several risk factors for cholesterol gallstone formation in the general population have been identified. There is a strongly increased risk of gallstone disease during prolonged fasting, rapid weight loss, total parenteral nutrition, and somatostatin(-analogue) treatment. The annual risk of biliary colic and gallstone complications in asymptomatic gallstone carriers has been investigated sparsely. In asymptomatic and symptomatic gallstone carriers, treatment with the hydrophilic bile salt ursodeoxycholic acid (UDCA) has been claimed to reduce the risk of biliary colic and gallstone complications such as acute cholecystitis and acute pancreatitis. Also, prophylactic cholecystectomy could be beneficial in certain subgroups of asymptomatic gallstone carriers. However, randomized, double-blind, placebo-controlled trials are lacking. In this review, strategies for the prevention of gallstone formation in the general population and in high-risk conditions are dealt with. Also, strategies for the prevention of biliary colic and gallstone complications in asymptomatic and symptomatic gallstone carriers are discussed.
Venneman
Niels G
NG
Gastrointestinal Research Unit, Department of Gastroenterology, University Medical Center Utrecht, The Netherlands. nielsvenneman@hotmail.com
van Erpecum
Karel J
KJ
D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000209:etiology / Q000517:prevention & control*; D002784:Cholesterol / Q000378:metabolism; D004032:Diet; D005260:Female; D042882:Gallstones / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000209:etiology; D012307:Risk Factors; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use; D015431:Weight Loss
D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid; D002784:Cholesterol