“Bad news, as I just had a gallstone attack” Nearly half of pt’s with symptoms but uncomplicated gallstone dz can be managed successfully with observation and dietary management (“avoid all foods that aggravate your sx’s”) (Scand J Gastro 2002;37:834-9). Generally, only persons with sx’s related to the presence of gallstones (steady, nonparoxysmal pain lasting 4-6 hours located in the upper abd) or complications (acute cholecystitis or gallstone pancreatitis) warrant surgical intervention.
• Outcomes were not improved with more-restrictive selection criteria for surgery in biliary colic, but the restrictive strategy reduced the number of surgeries (Lancet 2019 Apr 26;e-pub). Investigators in the Netherlands conducted a multicenter, randomized, noninferiority study that compared outcomes in 1067 participants who were selected for surgery either at the surgeon’s discretion (standard-care group) or according to more-stringent criteria (restrictive-strategy group). Patients in the restrictive-strategy group had to meet five clinical criteria for cholecystectomy: severe pain attacks, pain lasting 15 minutes or longer, epigastric or right upper quadrant pain, pain radiating to the back, and pain that responded to analgesic therapy. The percentage of patients who were pain free 12 months after surgery (the primary endpoint) was similar in the restrictive-strategy and standard-care groups (56% and 60%, respectively); thus, noninferiority was not shown with more-restrictive surgical criteria. However, significantly fewer patients in the restrictive-strategy group than in the standard-care group underwent surgery (68% vs. 75%). The that many patients in both groups failed to become pain free, which suggests that the original working diagnosis in some patients may have been incorrect and that surgery may have been the wrong treatment. Suggesting that perhaps cholecystectomy should be performed in a more limited manner, possibly in patients with clear findings of cholecystitis versus those with occasional biliary colic.
Thank you!
I don’t feel bad. And that was my only attack—I think over the past few years I’ve had two flareups that I thought were heartburn. But if this is all I have right now, I can go on like this forever.
Do you know what the deal is with the drug udosil (Sp)? They say it can reduce gallstones, but it doesn’t seem to be the first choice.
I DID have an attack that lasted 3 hours when I went to the ER, and it passed within the hour, and thank God for morphene. Ultrasound showed stones, but like I say, they haven’t been a problem in the past except when I eat really specific foods (tuna fish with lots of mayonnaise, for ex).