Asymptomatic Gallstone Disease

Definitions:

Asymptomatic Gallstones: the presence of gallstones detected incidentally in patients who do not have any abdominal symptoms or have symptoms that are not thought to be due to gallstones. Diagnosis is made during routine ultrasound for other abdominal conditions or, occasionally, by palpation of the gall bladder at operation. This definition implies that we know which symptoms are specific to gallstones.

Gallstone symptoms: Pain at right hypochondrium or epigastrium, often radiating to the right shoulder forcing the patient to rest and not relieved by bowel movement. Most commonly the pain is constant not colicky. The Danish prevalence study identified "right upper quadrant pain during the night" as the most discriminating symptom in men and "strong and oppressive pain, provoked by fatty meals" as the symptom best correlating with the presence of gallstones in women. Many patients present with vague indigestion and bloating which are more likely to be related to irritable bowel syndrome. However sometimes it is very difficult to decide whether gallstones are or are not causing the symptoms. For example, the location of the pain is often epigastric and this may be misinterpreted as peptic ulcer disease particularly if the pain comes on after meals and at night.

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Core Review Team

• Alan G. Johnson (UK)
• Michael Fried (Switerland)
• Guido Tytgat (The Netherlands)
• Justus H. Krabshuis (France)

Special Advisors:

• Roque Saenz (Chile)
• Martin Carey (USA)
• Sum P. Lee (Hong Kong)

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