Cholesterol gallstones: Pathophysiology, risk factors, diagnostic approaches, and contemporary management strategies-an updated review
Keywords:
Cholesterol gallstones, Cholelithiasis, Cholesterol metabolism, Gallbladder motility, Bile acids, Ursodeoxycholic acid, Insulin resistance, Gut microbiota, Prevention, CholecystectomyAbstract
Background: Cholesterol gallstone disease is one of the most prevalent gastrointestinal disorders worldwide and represents a major cause of healthcare utilization and surgical intervention. Although many individuals remain asymptomatic, symptomatic disease can result in recurrent biliary pain and serious complications. Increasing evidence indicates that cholesterol gallstone formation is a multifactorial process involving genetic susceptibility, metabolic abnormalities, altered cholesterol homeostasis, gallbladder dysmotility, bile supersaturation, inflammatory responses, intestinal cholesterol absorption, and gut microbiota alterations. Aim: This review aimed to provide a comprehensive overview of the pathogenesis, risk factors, current therapeutic approaches, and emerging preventive strategies for cholesterol gallstone disease. Methods: A narrative review of contemporary literature was conducted, focusing on the molecular, metabolic, and clinical mechanisms underlying cholesterol gallstone formation, current management options, and potential future therapeutic targets. Results: Cholesterol gallstones account for more than 80% of gallstone cases and arise from complex interactions between systemic metabolic dysfunction and local gallbladder abnormalities. Laparoscopic cholecystectomy remains the standard treatment for symptomatic disease, while ursodeoxycholic acid provides benefit in carefully selected patients. Lifestyle modification, including weight management, healthy dietary patterns, and regular physical activity, plays a critical role in primary prevention.
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