Gallstone disease is one of the major digestive diseases: 10-20% of Europeans and Americans carry gallbladder stones1'2. Each year an estimated 700000 cholecystectomies are performed in the USA. Cholelithiasis incurs annual medical expenses of $6.5 billion in the USA and is the second most expensive digestive disease, exceeded currently only by gastro-oesophageal reflux disease. Epidemiological studies in high-risk populations indicate that gallstone formation is caused by multiple environmental genetic factors and their interactions3. Gallstone prevalence is highest in some American populations, in particular Amerindians4. Significant risk factors for gallstones are age, female gender, parity and a high-caloric, high-carbohydrate and low-fibre diet. Gallstones appear to be associated with the metabolic syndrome and its major components, such as hypermsulinism, dyslipidaemia, and abdominal adiposity. Enterohepatic infections, specifically by Helicobacter species, have been implicated in cholelithiasis and cholecystitis.
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