NATURAL-HISTORY OF ASYMPTOMATIC GALLSTONES IN FAMILY-PRACTICE OFFICE PRACTICES

Background: Improved access to less invasive testing has resulted in m ore Americans being diagnosed with asymptomatic gallstones. The family physician has had to rely on community-based or referral patient stud ies to advise their office-based patients about treatment options. Obj ective: To understand the natural history of asymptomatic gallstones d iscovered through a routine patient care process in a rural, office-ba sed research network of 9 family physician practices. Participants and Methods: Nine family physician practices agreed to comb their records for medical records of patients found to have asymptomatic gallstones during their routine primary care practice. Medical records were then reviewed annually for 5 years for evidence of gallstone-related probl ems Results were compared with previous English-language literature st udies. Results: Asymptomatic gallstones were found in 32 patients (19 women [59%] and 13 men [41%] with an average age of 59.5 years). Sympt oms developed in 8 patients (25%) after an average latency period of 3 years 5 months. Seven patients underwent cholecystectomy; there was n o gallstone-related mortality in this group. One patient who developed a ruptured gallbladder required an emergency procedure. Conclusions: Routine office practice is detecting only a small percentage of the as ymptomatic gallstones expected by community-based screening studies. W hile more of these patients became symptomatic than in general populat ion studies, most patients with asymptomatic gallstones required no tr eatment. Those patients in family practice offices who are serendipito usly found to have gallstones can generally be followed up conservativ ely.