Gallstones: prevention, diagnosis and treatment

Gallstones are common and affect up to 20 % of the general adult population and > 20 % of them will develop symptoms or complications. Laparoscopic cholecystectomy is indicated for symptomatic gallstones, as the risk of recurrence or complications increases over the course of the disease. Biliary colic is treated with non-steroidal anti-inflammatory drugs; spasmolytics and opioids can also be used in cases of severe pain. The high risk of gallbladder stone formation can be reduced by ursodeoxycholic acid in the case of significant weight reduction resulting from diet or bariatric surgery. Acute cholecystitis represents a common complication of gallbladder stones and should be operated on early electively, i.e., within 24 hours of admission to hospital. Symptomatic bile duct stones are primarily treated endoscopically. Immediate antiinfective therapy is mandatory in acute cholangitis. Although new knowledge on the genetics and pathophysiology of gallstones has been generated, current treatment algorithms remain predominantly invasive, based on interventional endoscopy and surgery. Future future efforts should focus on novel preventive strategies to prevent the development of gallstones aforehand.