Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study

J Gastroenterol Hepatol. 2010 Apr;25(4):719-24. doi: 10.1111/j.1440-1746.2009.06146.x.


Background and aims: 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.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Chi-Square Distribution
  • Cholecystectomy / adverse effects
  • Cross-Sectional Studies
  • Disease Progression
  • Female
  • Gallstones / complications
  • Gallstones / diagnostic imaging
  • Gallstones / epidemiology*
  • Gallstones / surgery
  • Humans
  • Italy / epidemiology
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Selection
  • Population Surveillance
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • Ultrasonography