Worden galsteencomplicaties voorafgegaan door galsteenkolieken?*

Objective

To determine how often complicated gallstone disease is preceded by biliary colics and to evaluate the process of diagnosis and treatment of patients with biliary colics.

Design

Descriptive study.

Method

A standardised case history was taken from 175 consecutive patients with complicated gallstone disease, such as acute biliary pancreatitis (n = 53), symptomatic choledocholithiasis (n=64) and acute cholecystitis (n = 58). The definition ‘biliary colic’ was validated in 175 consecutive patients, who were on the waiting list for cholecystectomy because of symptomatic uncomplicated cholelithiasis.

Results

More than half (57%, 95% CI: 50-65) of the 175 patients with complicated gallstone disease had experienced episodes of biliary colic. In patients with pancreatitis this was 58%, with choledocholithiasis 67% and with cholecystitis 45%. Prior to the onset of the complication the patients experienced a median of 5 biliary colics over a period of 5 months. The majority (87%) of the 100 patients with complicated cholelithiasis and biliary colics had experienced delays in diagnosis or treatment. This was partly because they had not visited their general practitioner after a biliary colic and partly because their general practitioner had not referred them further. Patients with pain in the epigastric region were referred less often than patients with pain in the right upper quadrant (51 versus 38%, p = 0.03).

Conclusion

At least half of patients with complicated gallstone disease experienced prior biliary colics. Further research is needed to establish to what extent streamlining the process of diagnosis, referral and treatment of symptomatic cholelithiasis can prevent complicated gallstone disease.