Clinical manifestations of gallstone disease: Evidence from the multicenter Italian study on cholelithiasis (MICOL)

Despite the many efforts to delineate the clinical manifestations of gallbl adder disease, the precise symptom complex associated with gallstones is st ill a matter of debate, and even the existence of gallstone-specific sympto ms has been questioned. We carried out a large population-based cross-secti onal study (MICOL) to identify symptoms significantly related to gallstones , Fourteen centers throughout Italy enrolled 29,504 subjects aged 30 to 69 years. All subjects were administered an ultrasonographic examination of th e upper abdomen and a preceded questionnaire. All subjects were divided int o 4 groups: 25,374 (86.0%) gallstone-free subjects (GF), 1,832 (6.2%) patie nts with gallstones not previously diagnosed (GNPD), 638 (2.2%) patients wi th gallstones previously diagnosed (GPD), 1,660 (5.6%) patients with a hist ory of cholecystectomy for gallstones (CC). In logistic regression analysis , pain at epigastrium and, even more, pain at right hypocondrium were signi ficantly associated with gallstones, For pain at right hypocondrium, this a ssociation progressively increased from GNPD (OR = 1.60, 95% CI = 0.97-2.65 ) to GPD (OR = 8.77, 95% CI = 5.27-14.61) to CC (OR = 59.40, 95% CI = 43.87 -80.42). Absence of heartburn combined with right hypocondrium or epigastri um pain and intolerance to fried or fatty food were also significantly rela ted to gallstones. We also found some pain characteristics significantly as sociated with gallstones, i.e,, pain radiated to the right shoulder, forcin g the patient to rest, occurring soon after meals or unrelated to meals, no t relieved by bowel movements, and frequently accompanied by gallstone-rela ted morbidities. We developed a probability tree reporting the cumulative p robability of having gallstones for each combination of those symptoms and characteristics of pain significantly associated with gallstones, In conclu sion, we have identified symptoms and signs significantly associated with g allstones. We have shown that there is an increase in frequency and severit y of these symptoms and signs across the different stages of gallstone dise ase. We have proposed a complex of symptoms and signs significantly associa ted with gallstones that might help physicians in clinical decision making.