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Gallstones: how do we translate an old story into future therapy?

Nature Clinical Practice Gastroenterology & Hepatology volume 1, pages 2–3 (2004)Cite this article

According to autopsy studies of Egyptian and Chinese mummies, biliary stones have apparently troubled mankind for at least 40 centuries. The malady has not disappeared, but has continued to be a common, troublesome and expensive problem, perhaps because of environmental factors as well as the genetic predisposition of humans to the development of biliary stones. The incidence of gallstones varies worldwide but no less than 26 million Americans (12–15% of the adult population) carry stones in the gallbladder. So what have we learned in the last two decades and what can we look forward to in the future?

The prevalence of gallstones seems to be rising.1 Risk factors for the development of gallstones include obesity (especially central obesity), medications, ethnic background and genetic predisposition. Gallstones are more common in women and are associated with multiparity and the use of contraceptive pills containing high doses of estrogen; whether low-dose estrogen contraceptives pose the same risk is not well studied. Cholesterol gallstones increase in prevalence with age, however, the exact mechanism by which this happens is not well understood. Gallstones and stones in the biliary system are important risk factors for the development of gallbladder cancer and cholangiocarcinoma. Indeed, gallbladder cancer is common in populations where the incidence of gallstones is high, such as in Native Americans and Hispanic Americans of Mexican descent, and there has been a global increase in the incidence of cholangiocarcinoma.1 So, if we can treat, or better still, prevent gallstone formation, we might be able to reduce dramatically the incidence of these deadly and usually unresectable gallbladder cancers.

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  1. Professor of Medicine and Head of Gastroenterology/Hepatology at the University of Washington School of Medicine, Washington, USA

    Sum Lee

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Correspondence to Sum Lee.

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Lee, S. Gallstones: how do we translate an old story into future therapy?. Nat Rev Gastroenterol Hepatol 1, 2–3 (2004). https://doi.org/10.1038/ncpgasthep0017

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