1.Natural history of asymptomatic gallstones: differential behaviour in male and female subjects
Suneet Sood ; Than Winn ; Suraiya Ibrahim ; Anisha Gobindram ; A. Allirani V Arumugam ; Norain Che Razali ; Putri Yasmin ; Norul Hidayu ; Hasri Sani ; Mohd Habib Mustafa ; Anis Fatinah ; Ambigga Devi ; Athifah Abdul Karim ; Kadhim Jawad Obaid ; Nor Hashim Haron ; Henry Fitjerald ; Marymol Koshy
The Medical Journal of Malaysia 2015;70(6):341-345
Objective: The natural history of asymptomatic (silent)
gallstones has been inadequately studied. Existing
information derives from studies based on oral
cholecystography or relatively small sample sizes. We
planned a retrospective cohort study in subjects with
gallstones to determine conversion rates from
asymptomatic to symptomatic.
Methods: We extracted data from computerised databases
of one government hospital and two private clinics in
Malaysia. Files were scrutinised to ensure that criteria for
asymptomatic gallstones were fulfilled. Patients were called
on telephone, further questioned to confirm that the
gallstones at detection were truly asymptomatic, and asked
about symptoms that were consistent with previously
defined criteria for biliary colic. Appropriate ethical
clearances were taken.
Results: 213 (112 males) patients fulfilled the criteria for
asymptomatic gallstones and could be contacted. 23 (10.8%)
developed pain after an average follow up interval of 4.02
years (range 0.1-11 years). Conversion rates from
asymptomatic to symptomatic gallstones were high in the
first two years of follow up, averaging 4.03±0.965 per year.
Over time the conversion rates slowed, and by year 10 the
annual conversion rate averaged only 1.38±0.29. Conversion
rates were much higher for females compared to males (F:M
hazard ratio 3.23, SE 1.54, p>z 0.014). The lifetime risks for
conversion approached 6.15% for males, and 22.1% for
females.
Conclusion: In conclusion, asymptomatic gallstones are
much more likely to convert to symptomatic in females than
in males. Males in whom asymptomatic stones are
discovered should be advised conservative treatment.
Surgery may be preferable to conservative management if
the subject is a young female.
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