Gallstones are certainly not going away

Review by Prof. Eamonn Quigley (USA)

Study Summary 

Gallstones have been with us for millennia and while many remain asymptomatic, for some cholelithiasis can lead to cholecystitis, choledocholithiasis and pancreatitis with considerable resultant morbidity and some deaths, especially among vulnerable populations. In recent decades there have been significant demographic and socio-cultural shifts among inhabitants of all continents leading one to ask the question – have these changes in diet, body habitus an disease patterns affected the global prevalence of gall stones?

This meta-analysis examined the prevalence and incidence of gallstones from 2000 to 2023. 115 studies including over 32 million participants were included. The global prevalence of gallstones was between 5.5 and 6.7% depending on diagnostic criteria; more common in females (7.65 vs 5.4% in males), among older individuals and, in terms of geography, most common in South America (11.2% vs 5.1% in Asia, 6.6% in Africa, 6.4% in Europe and 8.1% in North America. Detection rates were highest (and presumably, most accurate) among those studies that employed imaging, either ultrasonography or CT scanning. 

Commentary 

This is a timely reminder that gallstones remain very common around the world and especially so in South America where there are populations who may be genetically predisposed to cholelithiasis. Comparing data derived from medical records (which we assume reflect those with symptomatic disease) with those obtained from screening using an imaging modality suggests that about two thirds are asymptomatic. The remaining third represent a sizeable fraction of the population and, given that cholecystectomy remains the only well validated therapeutic option, their disease will pose a significant burden on health care budgets around the world. One can propose many reasons for the continuing high prevalence of gallstones in our communities; the delineation of the main causative factors should promote preventative measures and observations from this study should allow us to focus our efforts on those at greatest risk.

Citation

Wang X, Yu W, Jiang G, et al. Global epidemiology of gallstones in the 21^st century: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2024;22:1586-95.

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