Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study.
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.
Festi
Davide
D
Department of Clinical Medicine, University of Bologna, Bologna, Italy. davide.festi@unibo.it
Reggiani
Maria Letizia Bacchi
ML
Attili
Adolfo F
AF
Loria
Paola
P
Pazzi
Paolo
P
Scaioli
Eleonora
E
Capodicasa
Simona
S
Romano
Ferdinando
F
Roda
Enrico
E
Colecchia
Antonio
A
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