What is cholelithiasis (gallstones)?

From the Guidelines

Cholelithiasis, or gallstones, are hardened deposits that form in the gallbladder, often causing no symptoms, but potentially leading to severe pain, nausea, vomiting, and other complications if they block bile ducts. These stones develop when substances in bile, primarily cholesterol and bilirubin, crystallize and solidify, and can vary in size from tiny grains to golf ball-sized masses, being single or multiple 1. The risk factors for gallstones include female gender, obesity, rapid weight loss, pregnancy, certain medications, and genetic predisposition, and treatment depends on symptom severity, with asymptomatic gallstones typically requiring no treatment, while symptomatic cases may need medication to dissolve stones, shock wave therapy, or more commonly, surgical removal of the gallbladder (cholecystectomy) 2. Some key points to consider in the management of gallstones include:

• The categorization of disease into silent gallstones (asymptomatic disease), disease that causes uncomplicated biliary pain (symptomatic disease), and complications of gallstone disease, such as acute cholecystitis and gallbladder cancer 3.
• The potential benefits and risks of different treatment options, including expectant management, nonsurgical therapy, and surgical removal of the gallbladder, and the importance of considering the efficacy, safety, and benefits of each option 4.
• The role of gallbladder cancer in decision making for patients with symptomatic gallstones, and the potential advantages of cholecystectomy in removing the threat of gallbladder cancer 5. In general, the treatment of gallstones should prioritize preventing future biliary pain, complications, or death, while also considering the patient's individual circumstances and the potential risks and benefits of different treatment options. The decision-making process should consider whether the disease is asymptomatic or symptomatic, and the patient's overall health and quality of life, with the goal of minimizing morbidity, mortality, and improving quality of life 1, 2.

From the FDA Drug Label

Although liver injury has not been associated with ursodiol therapy, a reduced capacity to sulfate may exist in some individuals, but such a deficiency has not yet been clearly demonstrated. The various actions of ursodiol combine to change the bile of patients with gallstones from cholesterol-precipitating to cholesterol-solubilizing, thus resulting in bile conducive to cholesterol stone dissolution. On the basis of clinical trial results in a total of 868 patients with radiolucent gallstones treated in 8 studies

Cholelithiasis (gallstones) refers to the formation of stones in the gallbladder, often composed of cholesterol.

• The formation of these stones is related to the precipitation of cholesterol in the bile.
• Ursodiol works by changing the bile composition to make it more conducive to cholesterol stone dissolution.
• Gallstones can be radiolucent (not visible on X-rays) or calcified (visible on X-rays), with radiolucent gallstones being more likely to dissolve with Ursodiol therapy 6.

From the Research

Definition and Overview of Cholelithiasis

• Cholelithiasis refers to a condition in which hardened deposits, known as gallstones, exist within the gallbladder 7.
• These gallstones can cause various symptoms, particularly when they lead to inflammation or blockage of the bile duct, affecting 10-25% of patients with cholelithiasis 7.
• The condition is associated with the highest hospital admissions among other gastrointestinal diseases 7.

Epidemiology and Pathogenesis

• Cholelithiasis can occur in individuals of all ages, including children, with different predisposing factors and clinical presentations 8.
• In children, idiopathic gallstones and those associated with hemolytic diseases are common, while in adults, the condition is often asymptomatic until complications arise 7, 8.
• The pathogenesis of cholelithiasis may differ from that of sludge, a dynamic condition that can develop and disappear within a few days 8.

Clinical Presentations and Complications

• Symptoms of cholelithiasis may include biliary colic, diarrhea, acute cholecystitis, and acute pancreatitis 9.
• Complications can occur in patients with cholelithiasis, including recurrence of abdominal symptoms after treatment 8.
• The presence of gallstones in the common bile duct, known as choledocholithiasis, requires prompt management to prevent further complications 7.

Management and Treatment Options

• Various treatment options are available for cholelithiasis, including oral dissolution therapy, extracorporeal shock wave lithotripsy, and surgical interventions such as cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) 10, 9, 11.
• The choice of treatment depends on the individual patient's condition, the size and number of gallstones, and the presence of complications 10, 9.
• A comprehensive approach to management, including litholytic therapy and treatment directed towards metabolic normalization, may improve treatment outcomes 11.