Body habitus: obesity, * rapid weight loss, cyclic weight loss

Many patients with gallstones can be managed expectantly. Generally, only persons with symp-toms related to the presence of gallstones (e.g., steady, nonparoxysmal pain lasting four to six hours located in the upper ahdomen) or complications (such as acute cholecystitis or gallstone pancreatitis) warrant surgical intervention. Biliary pain is alleviated by cholecystectomy in the majority of cases. Laparoscopic cholecystectomy is considered the most cost-effective manage-ment strategy in the treatment of symptomatic gallstones. Medical management strategies are mostly palliative and are not widely supported. Patients with longer-lasting biliary pain, in com-. bination with abdominal tenderness, fever, and/or leukocytosis, require an ultrasound evaluation to help establish a diagnosis of acute cholecystitis. Once a patient is diagnosed, having cholecys-tectomy early in the course of the disease can significantly reduce the hospital stay. (Am Fam Physician 2005;72:637-42. Copyright © 2005 American Academy of Family Physicians.) Gallstone disease affects 12 percentof the population in the UnitedStates. Several factors are associ-ated with an increased occurrence of gallstone formation (Table 1). In a multi-variate analysis ' of more than 900 patients, researchers identified a family history of cholecystectomy in a first-degree relative and obesity (defined as body mass index [BMI] greater than 30 kg per m) ̂ as strong risk fac-tors for symptomatic gallstone disease with a relative risk of 2.2 (95 % confidence interval [CI], 1.5 to 3.0) and 3.7 (95 % CI, 2.3 to 5.3), respectively. Weight loss patterns also are associated with symptomatic gallstones. Weight los