Gallstones: current concepts of pathogenesis and medical dissolution

Gallstone disease constitutes a major health problem in the western world, despite a successful form of surgical therapy, cholecystectomy. The past decade has witnessed considerable advances in our understanding of the physiochemical changes in bile that lead to cholesterol gallstone formation. This knowledge has resulted in a rational basis for identifying agents that could dissolve gallstones and for defining conditions that predispose to gallstone formation which might be eliminated or treated prophylactically. This review examines the concepts of gallstone formation and indicates the current status of medical therapy.