Metabolic dysfunction-associated gallstone disease: expecting more from critical care manifestations

• Published in: Internal and emergency medicine Vol. 18; no. 7; pp. 1897 - 1918
• Main Authors: Portincasa, Piero, Di Ciaula, Agostino, Bonfrate, Leonilde, Stella, Alessandro, Garruti, Gabriella, Lamont, John Thomas
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2023; Springer Nature B.V
• Subjects: Adipose tissue; Adult; Calculi; Cholecystectomy; Cholesterol; Cholesterol - metabolism; Clinical aspects; Crystals; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Disease prevention; Gallstones; Gallstones - complications; Gallstones - diagnosis; GUT inflammation in human health and disease; Homeostasis; Humans; Im - Review; Insulin resistance; Internal Medicine; Liver; Medicine; Medicine & Public Health; Metabolic Diseases - metabolism; Metabolic syndrome; Metabolism; Patients; Cholecystectomy; Choledocholithiasis; MRCP; Biliary secretion; Cholesterol crystallization; Biliary colic; ERCP; Cholecystitis; CT scan; Bile
• ISSN: 1828-0447; 1970-9366; 1970-9366
• DOI: 10.1007/s11739-023-03355-z

About 20% of adults worldwide have gallstones which are solid conglomerates in the biliary tree made of cholesterol monohydrate crystals, mucin, calcium bilirubinate, and protein aggregates. About 20% of gallstone patients will definitively develop gallstone disease, a condition which consists of gallstone-related symptoms and/or complications requiring medical therapy, endoscopic procedures, and/or cholecystectomy. Gallstones represent one of the most prevalent digestive disorders in Western countries and patients with gallstone disease are one of the largest categories admitted to European hospitals. About 80% of gallstones in Western countries are made of cholesterol due to disturbed cholesterol homeostasis which involves the liver, the gallbladder and the intestine on a genetic background. The incidence of cholesterol gallstones is dramatically increasing in parallel with the global epidemic of insulin resistance, type 2 diabetes, expansion of visceral adiposity, obesity, and metabolic syndrome. In this context, gallstones can be largely considered a metabolic dysfunction-associated gallstone disease, a condition prone to specific and systemic preventive measures. In this review we discuss the key pathogenic and clinical aspects of gallstones, as the main clinical consequences of metabolic dysfunction-associated disease.