Abstract
Gallstones affect 20% of the Western population and will grow in clinical significance as obesity and metabolic diseases become more prevalent. Gallbladder removal (cholecystectomy) is a common treatment for diseases caused by gallstones, with 1.2 million surgeries in the US each year, each costing USD 10,000. Gallbladder disease has a significant impact on the logistics and economics of healthcare. We discuss the two most common presentations of gallbladder disease (biliary colic and cholecystitis) and their pathophysiology, risk factors, signs and symptoms. We discuss the factors that affect clinical care, including diagnosis, treatment outcomes, surgical risk factors, quality of life and cost-efficacy. We highlight the importance of standardised guidelines and objective scoring systems in improving quality, consistency and compatibility across healthcare providers and in improving patient outcomes, collaborative opportunities and the cost-effectiveness of treatment. Guidelines and scoring only exist in select areas of the care pathway. Opportunities exist elsewhere in the care pathway.
Highlights
Cholelithiasis is considered a major public health problem in developed countries, and its symptoms and complications can generate major economic and social burden
There is clinical opinion that white cell count (WCC) is preferable for distinguishing between cholecystitis and biliary colic (BC), as CRP levels will be raised in both, and they can be distinguished with other features [72]
[82], it is likely that the judgement of Bree inor speon diagnostic criteria and the patient cohort,assessment it has been found to be either highly sensitive cific for diagnosis of acute cholecystitis, but not both [69]
Summary
Cholelithiasis (gallstone formation, presenting symptomatically as biliary colic) is considered a major public health problem in developed countries, and its symptoms and complications can generate major economic and social burden. In 2008, it was estimated that 14.2 million women and 6.3 million men had gallbladder disease (GD) in the USA and that 1.2 million cholecystectomies (removal of the gallbladder) are performed each year [1]. There is great variability worldwide regarding the known prevalence of gallstones, in part because the disease may be asymptomatic. Chile, Sweden, Germany and Austria, whereas Asian populations appear to have the lowest incidence of gallstone disease [10–13]. In France to 43.0% in Sweden [16], and this may reflect differences in clinical practice It suggests that improvements may be possible in the quality of care and the efficiency of its delivery if improvements can be made to prognosis and management in a way that facilitates a higher proportion of planned early cholecystectomies
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