G Morris-Stiff et al. Clin Gastroenterol Hepatol 2023; 21: 319=327. The Natural History of Asymptomatic Gallstones: A Longitudinal Study and Prediction Model

Using a retrospective cohort design with 22,257 patients (51% female) with a mean age of 61 years, Key Findings:

• There was a 2% per year rate of developing symptomatic gallstones
• Overall, 14.5% developed symptoms with a median followup of 4.6 years
• Cumulative incidence of becoming symptomatic: 10.1% at 5 years, 21.5% at 10 years, and 32.6% at 15 years
• The strongest predictors of developing SGs were female gender (hazard ratio [HR], 1.50), younger age (HR per 5 years, 1.15), multiple stones (HR, 2.42), gallbladder polyps (HR, 2.55), large stones (>9 mm) (HR, 2.03), and chronic hemolytic anemia (HR, 1.90). Elevated BMI was associated with increase risk; for example a BMI >40 had a HR of 1.60.
• Statin use was associated with a reduced risk of with HR 0.61

My take: This large retrospective study of adults indicates that if given enough time, more than 1/3rd of individuals will develop symptomatic gallstones. Surgical intervention should be considered in those with significant risk factors.

Related blog posts:

• Which patients with asymptomatic gallstones need a cholecystectomy?
• Intervention in Gallbladder Disease | gutsandgrowth
• Early Surgery for Acute Uncomplicated Cholecystitis | gutsandgrowth
• Biliary Dyskinesia -“Only in America” | gutsandgrowth

Dog’s viewpoint at the Chattahoochee River in Sandy Springs, GA