Metabolic factors in pathogenesis of cholesterol gallstones: implications for gallstone prevention
Current treatment of clinical gallstone disease is generally successful. Cholecystectomy carries a low mortality and usually effects a complete cure. The recent introduction of pharmacological dissolution of cholesterol gallstones with oral administration of bile acids (chenodeoxycholic acid and ursodeoxycholic acid) appears to be an important addition to therapy of gallstones1. Despite these good therapeutic modalities for treatment of existing cholelithiasis, gallstones remain an important cause of morbidity and mortality. The prevalence of gallstones in many populations is enormous. Cholecystitis and obstructive jaundice are common clinical problems throughout the world. Although the risks for mortality from gallbladder disease and cholecystectomy are relatively lower in young and middle-aged adults, the risk increases greatly with advancing years. Gallstone disease is also costly both in financial terms and in time lost from work. For these reasons consideration must be given to whether gallstones can be prevented. If prevention is both possible and practical, the benefits would be great. The purpose of this review is to examine the question of gallstone prevention in the light of current knowledge about the pathogenesis of cholesterol stones. Therefore the mechanisms responsible for gallstone formation will be reviewed first, and the concept of risk factors for gallstone disease will be developed. If risk factors working through known pathogenic mechanisms can be identified and modified, they might provide a foundation upon which to develop a programme of gallstone prevention.
KeywordsBile Acid Mixed Micelle Gallstone Disease Chenodeoxycholic Acid Gallstone Formation
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