title: Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study.
abstract: OBJECTIVE
  The knowledge of natural history is essential for disease management. We evaluated the natural history (e.g. frequency and characteristics of symptoms and clinical outcome) of gallstones (GS) in a population-based cohort study.
  
  
  METHODS
  A total of 11 229 subjects (6610 men, 4619 women, age-range: 29-69 years, mean age: 48 years) were studied. At ultrasonography, GS were present in 856 subjects (338 men, 455 women) (7.1%). GS were followed by means of a questionnaire inquiring about the characteristics of specific biliary symptoms.
  
  
  RESULTS
  At enrollment, 580 (73.1%) patients were asymptomatic, 94 (11.8%) had mild symptoms and 119 (15.1%) had severe symptoms. GS patients were followed up for a mean period of 8.7 years; 63 subjects (7.3%) were lost to follow up. At the end of the follow up, of the asymptomatic subjects, 453 (78.1%) remained asymptomatic; 61 (10.5%) developed mild symptoms and 66 (11.4%) developed severe symptoms. In subjects with mild symptoms, the symptoms disappeared in 55 (58.5%), became severe in 23 (24.5%), remained stable in 16 (17%); in subjects with severe symptoms, the symptoms disappeared in 62 (52.1%), became mild in 20 (16.8%) and remained stable in 37 (31.1%). A total of 189 cholecystectomies were performed: 41.3% on asymptomatic patients, 17.4% on patients with mild symptoms and 41.3% on patients with severe symptoms.
  
  
  CONCLUSIONS
  This study indicates that: (i) asymptomatic and symptomatic GS patients have a benign natural history; (ii) the majority of GS patients with severe or mild symptoms will no longer experience biliary pain; and (iii) a significant proportion of cholecystectomies are performed in asymptomatic patients. Expectant management still represents a valid therapeutic approach in the majority of patients.
authors.affiliation: Department of Clinical Medicine, University of Bologna, Bologna, Italy. davide.festi@unibo.it
authors.forename: Davide
authors.initials: D
authors.lastname: Festi
authors.forename: Maria Letizia Bacchi
authors.initials: ML
authors.lastname: Reggiani
authors.forename: Adolfo F
authors.initials: AF
authors.lastname: Attili
authors.forename: Paola
authors.initials: P
authors.lastname: Loria
authors.forename: Paolo
authors.initials: P
authors.lastname: Pazzi
authors.forename: Eleonora
authors.initials: E
authors.lastname: Scaioli
authors.forename: Simona
authors.initials: S
authors.lastname: Capodicasa
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Romano
authors.forename: Enrico
authors.initials: E
authors.lastname: Roda
authors.forename: Antonio
authors.initials: A
authors.lastname: Colecchia
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002763:Cholecystectomy / Q000009:adverse effects; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011159:Population Surveillance; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography