[The medical therapy of cholelithiasis. Critical reflections]

Gallbladder stones can be asymptomatic, symptomatic or complicated. Medical therapy can be indicated only in patients with symptomatic gallstones. Indications to medical therapy is today limited by the knowledge of the benign natural history of the disease and by the availability of new surgical techniques, such as laparoscopic cholecystectomy. The ideal patient to be treated by medical therapy is mildly symptomatic, non obese, with functioning gallbladder and with radiolucent, floating stones, not larger than 5 mm in diameter. This type of patient represents only 3% of the population of gallstone patients and has a 90% likelihood of having complete stone dissolution after one year of treatment with ursodeoxycholic acid (12 mg/kg of body weight/day). Medical treatment can be proposed also in patients with stones up to 10 mm in diameter, but the likelihood of complete dissolution after one year drops to 60%, thus, treatment is indicated only in selected or high-risk patients. Ursodeoxycholic acid therapy can be useful in patients with biliary sludge or microlithiasis, especially if recently developed.