The burden of gallstone disease in Europe.

Abstract

Gallstones are common and may be associated with recurrent bouts of upper abdominal pain, often with nausea and ⁄ or vomiting. The frequency of gallstones increases with age, female gender and obesity. The majority of gallstones are asymptomatic. Despite this, gallstone disease is the most common abdominal condition for which patients are admitted to hospital in developed countries. Medical presentations usually result from complications or through routine investigations for abdominal pain. Complications attributable to gallstones include chronic inflammation ⁄ infection of the gallbladder (cholecystitis), abscess formation, and biliary obstruction, which can result in jaundice or a severe ascending infection of the bile ducts and acute pancreatitis. Most uncomplicated cases that present to clinicians can be effectively treated by keyhole surgery (laparoscopic cholecystectomy), but patients with more severe disease often require multidisciplinary management, involving radiological, gastroenterological and surgical services. Medical management other than the use of antibiotics to treat infection are infrequently employed due to the poor long-term response rates. Although now uncommon, severe cases can be associated with significant morbidity and mortality, particularly in frail or elderly patients. To determine the recent prevalence and incidence rates of gallstones, their complications and surgical treatments in Europe, a MedLine database search from 1989 to 2003 was performed.