[Epidemiology and pathogenesis of gallstones. Status of knowledge and therapeutic consequences]

The prevalence of gallstones in Europe is 7% for mean and 12 to 14% for women with figures increasing with age. Most gallbladder stones remain asymtomatic, leading to complications in less than 2%, and to biliary pain in 18% of initially asymptomatic patients over a period of 20 years. On the basis of such observations it has been concluded that only symptomatic gallbladder stones need to be treated. Stones in the bile ducts, however, must be removed whether symptomatic or not. In Europe more than 80% of gallbladder stones are cholesterol stones. The remaining stones are black pigment stones, composed predominantly of calcium bilirubinate. Brown pigment stones usually occur in the pathogenesis of cholesterol stones, may lead to new therapeutic or prophylactic approaches.