title: Which Abdominal Symptoms are Associated with Clinical Events in a Population Unaware of Their Gallstones? a Cohort Study.
abstract: High rates of persistent symptoms are found following cholecystectomy in patients with gallstones. The aim of this population based cohort study was to determine which symptoms were associated with the development of clinical gallstone events in a population unaware of their gallstones.
  
  
  
  Three random population samples from Copenhagen (N = 6037) were examined with ultrasound during 1982-1994. Participants were not informed about gallstone status. Abdominal symptoms were assessed at baseline through a questionnaire. Follow-up for clinical events was performed through central registers until 2011. Multivariable Cox regression analyses were performed.
  
  
  
  Participants unaware of their gallstones (N = 595) were followed for median 17.5 years. A total of 16.6% participants developed clinical events. Both uncomplicated and complicated events were associated with high pain intensity at baseline. Complicated events were also associated with pain at night. Uncomplicated events were associated with pain localized in the epigastrium, of longer duration, and in need of pain medication. No associations were identified for dyspepsia or irritable bowel syndrome.
  
  
  
  In a population of unaware gallstone carriers, it was possible to identify abdominal symptoms associated with later clinical detection of the gallstones. These finding may contribute to a better selection of patients for surgery.
authors.affiliation: Digestive Disease Center, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark. daniel.moensted.shabanzadeh.01@regionh.dk.|Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark. daniel.moensted.shabanzadeh.01@regionh.dk.
authors.forename: Daniel Mønsted
authors.initials: DM
authors.lastname: Shabanzadeh
authors.affiliation: Digestive Disease Center, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lars Tue
authors.initials: LT
authors.lastname: Sørensen
authors.affiliation: Digestive Disease Center, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark.|Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark.|Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.|The Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Jørgensen
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D000368:Aged; D001364:Awareness; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D042882:Gallstones / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014463:Ultrasonography
keywords: Cholelithiasis; Gallbladder diseases; Signs and symptoms; Ultrasonography