Symptomatic versus silent gallstones. Radiographic features and eligibility for nonsurgical treatment

It is unknown whether demography, gallbladder function, or the radiographic appearance of gallstones predispose them to cause symptoms. We investigated these features in a consecutive series of 260 patients with newly diagnosed, uncomplicated gallstone disease, of whom 146 had experienced biliary pain and 114 were asymptomatic. All patients underwent double-dose oral cholecystography and cholecystosonography, and the combined data of these examinations were used to assess gallbladder function and stone number, size, and radiopacity. The gallstones were multiple in 68%, radiolucent in 73%, and in visualized gallbladders in 79% of the 260 patients. The comparison of different variables in patients with and without biliary pain showed that the female gender (P = 0.030; odds ratio 1.86), a family history of gallbladder disease (P = 0.022; odds ratio 1.89), a nonvisualized gallbladder (P < 0.001; odds ratio 3.14), multiple stones (P = 0.036; odds ratio 1.89), and those which were small (P = 0.009; odds ratio 2.08) or of dissimilar size (P = 0.041; odds ratio 1.91) were associated with biliary pain. Women with silent stones had been pregnant more often (P < 0.001, difference between means 1) than those with biliary pain. Gallbladder function and the radiologic characteristics of stones were unrelated to age and gender. Estimates of eligibility for nonsurgical therapies among the 146 symptomatic patients were 44% for bile acid therapy, 16% for lithotripsy, and 56% for methyl tert-butyl ether. In conclusion, some inherent features of gallstones are associated with biliary pain. Whether they have predictive value of future symptom development in subjects with silent stones can be determined by prospective follow up.