What percentage of patients have cholelithiasis (gallstones)?

From the Guidelines

The estimated overall prevalence of gallstones is 10–15% in the general population. This percentage is based on the most recent and highest quality study available, which was published in 2020 by the World Society of Emergency Surgery 1. The study highlights that the prevalence of gallstones can vary across countries, but the estimated range of 10-15% provides a general guideline for clinicians to understand the scope of the issue.

Key Points to Consider

• The prevalence of gallstones is a significant concern, with a substantial portion of the population affected 1.
• Between 20 and 40% of patients with gallstones will develop gallstone-related complications, which can have a significant impact on morbidity, mortality, and quality of life 1.
• Understanding the prevalence of gallstones and the associated risk factors can help clinicians identify high-risk patients and provide appropriate preventive measures or earlier diagnostic evaluation when symptoms develop.

Risk Factors and Considerations

• Female gender, increasing age, obesity, rapid weight loss, certain ethnicities, family history, and certain medical conditions like diabetes or liver disease can increase the risk of developing gallstones 1.
• Pregnancy also increases the risk due to hormonal changes.
• The formation of gallstones typically results from imbalances in bile composition, with cholesterol stones being the most common type.

Clinical Implications

• Clinicians should be aware of the estimated overall prevalence of gallstones and the associated risk factors to provide appropriate care and management for patients.
• Early diagnosis and treatment can help reduce the risk of complications and improve patient outcomes.
• The management of patients with gallstones should be individualized, taking into account the patient's specific risk factors, medical history, and clinical presentation.

From the Research

Prevalence of Gallstones

• The prevalence of gallstones varies across different populations, with studies suggesting that:
  • About one fourth of women and 10% to 15% of men over the age of 50 are affected 2
  • The prevalence is as high as 60% to 70% in American Indians and 10% to 15% in white adults of developed countries 3
  • The pooled prevalence of gallstones is 6.1% (95% CI, 5.6-6.5) based on a systematic review and meta-analysis of 115 studies 4
• The prevalence of gallstones is higher in:
  • Females compared to males (7.6% vs 5.4%) 4
  • South America compared to Asia (11.2% vs 5.1%) 4
  • Upper-middle-income countries compared to high-income countries (8.9% vs 4.0%) 4
  • With advancing age 4

Incidence of Gallstones

• The incidence of gallstones is estimated to be 0.47 per 100 person-years (95% CI, 0.37-0.51) based on 12 studies 4
• The incidence of gallstones may be increasing, with higher rates in more recent studies 4

Risk Factors

• Principal risk factors for gallstones include:
  • Age
  • Sex (female)
  • Obesity
  • Ethnicity (American Indians and Mexican-Americans)
  • Childbearing
  • Abstinence from alcohol
  • Certain medications 2, 3, 5
• Modifiable risk factors include:
  • Obesity
  • The metabolic syndrome
  • Rapid weight loss
  • Certain diseases (cirrhosis and Crohn disease)
  • Gallbladder stasis (from spinal cord injury or drugs, such as somatostatin)
  • Lifestyle 3