Bile Metabolism and Cholelithiasis (A comprehensive review for the monthly publication Clinics of North America)

Background: Autopsies of Egyptian and Chinese mummies have demonstrated the existence of gallstones for at least 3,500 years. Today, gallstones occur commonly, especially in the West and in westernized societies. Gallstone complications include biliary colic, acute cholecystitis, choledocholithiasis, cholangitis, gallstone pancreatitis, and gallstone ileus. Gallstone disease exacts a considerable amount of financial and social burden worldwide. Gallstones lead to frequent physician visits and hospitalizations. In 2000, more than 750,000 outpatient visits in the United States were due to gallstones. In the same year, gallstone disease (defined as cholelithiasis with acute cholecystitis) was the most common inpatient diagnosis among gastrointestinal disorders, with more than 250,000 hospitalizations, a median inpatient charge of $11,584 (Russo, 2004) and an estimated annual cost of almost $6.5 billion. Notably, cholecystectomy is the most common elective abdominal operation performed in the United States, with more than 700,000 performed annually.