Natural history of asymptomatic gallstones in family practice office practices.
Zubler J. Markowski G. Yale S. Graham R. Rosenthal TC.
Department of Pediatrics, State University of New York, Buffalo 14215, USA.
BACKGROUND: Improved access to less invasive testing has resulted in more Americans being diagnosed with asymptomatic gallstones. The family physician has had to rely on community-based or referral patient studies to advise their office-based patients about treatment options. OBJECTIVE: To understand the natural history of asymptomatic gallstones discovered through a routine patient care process in a rural, office-based 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 problems Results were compared with previous English-language literature studies. RESULTS: Asymptomatic gallstones were found in 32 patients (19 women [59%] and 13 men [41%] with an average age of 59.5 years). Symptoms developed in 8 patients (25%) after an average latency period of 3 years 5 months. Seven patients underwent cholecystectomy; there was no 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 asymptomatic gallstones expected by community-based screening studies. While more of these patients became symptomatic than in general population studies, most patients with asymptomatic gallstones required no treatment. Those patients in family practice offices who are serendipitously found to have gallstones can generally be followed up conservatively.