Pathophysiology of cholesterol gallstone disease

Gallstone disease is one of the most costly digestive diseases requiring hospitalization in westernized countries, and its prevalence ranges from 10% to 15% in adults in Europe and the USA [1-4]. The burden of disease is summarized by the prevalence of patients with gallstones, by its incidence (over a million new diagnoses of gallstones a year), and by the number of cholecystectomies performed yearly in the USA (approaching 700,000) [5]. Similar trends in gallstone disease have been confirmed in large epidemiological surveys carried out in Italy [6-10]. In Western societies approximately 80% of gallstones are cholesterol gallstones [11], either pure cholesterol or mixed cholesterol stones (containing more than 50% cholesterol by weight).