Sex-Based Differences in

Gallstone disease causes significant morbidity andmortality in the United States. Gallstones occurin more than 20 million persons in the United States and affects ten percent of the adult population (1). The etiology of gallstone formation is multi-facto-rial and specific predisposing factors have been iden-tified. While environmental and genetic factors influ-ence gallstone formation, women beyond puberty are at a two- to threefold higher risk for cholelithiasis compared to men. The peak incidence of gallstones in women is between the ages of 30 and 39 years (2). These differences fade beyond menopause. Endogenous estrogen secretion may explain the observed gender differences in gallstone development (3,4). Women have smaller total bile acid pools and increased biliary cholesterol content that predisposes them to super-saturation of cholesterol in the bile pool, resulting in gallstone formation (5). Gallstones ofte