Primary prevention of gallstones typically focuses on lifestyle modification: a diet high in fibre, low in saturated fat, and maintenance of a normal body weight, combined with moderate physical activity.[1]European Association for the Study of the Liver (EASL). EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016 Jul;65(1):146-81.
https://www.journal-of-hepatology.eu/article/S0168-8278(16)30032-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/27085810?tool=bestpractice.com
[25]Zhang JW, Xiong JP, Xu WY, et al. Fruits and vegetables consumption and the risk of gallstone disease: a systematic review and meta-analysis. Medicine (Baltimore). 2019 Jul;98(28):e16404.
https://www.doi.org/10.1097/MD.0000000000016404
http://www.ncbi.nlm.nih.gov/pubmed/31305451?tool=bestpractice.com
[26]Aune D, Leitzmann M, Vatten LJ. Physical activity and the risk of gallbladder disease: a systematic review and meta-analysis of cohort studies. J Phys Act Health. 2016 Jul;13(7):788-95.
http://www.ncbi.nlm.nih.gov/pubmed/26901710?tool=bestpractice.com
[28]Williams CI, Shaffer EA. Gallstone disease: current therapeutic practice. Curr Treat Options Gastroenterol. 2008 Apr;11(2):71-7.
http://www.ncbi.nlm.nih.gov/pubmed/18321433?tool=bestpractice.com
[67]Leitzmann MF, Giovannucci EL, Rimm EB, et al. The relation of physical activity to risk for symptomatic gallstone disease in men. Ann Intern Med. 1998 Mar 15;128(6):417-25.
http://www.ncbi.nlm.nih.gov/pubmed/9499324?tool=bestpractice.com
[68]Banim PJ, Luben RN, Wareham NJ, et al. Physical activity reduces the risk of symptomatic gallstones: a prospective cohort study. Eur J Gastroenterol Hepatol. 2010 Aug;22(8):983-8.
http://www.ncbi.nlm.nih.gov/pubmed/20130468?tool=bestpractice.com
The evidence for a preventative effect of healthy lifestyle, diet, regular physical activity, and maintenance of an ideal body weight, however, is weak.[1]European Association for the Study of the Liver (EASL). EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016 Jul;65(1):146-81.
https://www.journal-of-hepatology.eu/article/S0168-8278(16)30032-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/27085810?tool=bestpractice.com
[69]Zhang YP, Zhao YL, Sun YL, et al. Physical activity and the risk of gallstone disease: a systematic review and meta-analysis. J Clin Gastroenterol. 2017 Oct;51(9):857-68.
http://www.ncbi.nlm.nih.gov/pubmed/27322529?tool=bestpractice.com
Preventative medical therapy with ursodeoxycholic acid (UDCA), which lowers cholesterol saturation in bile, can be used to reduce the short-term risk of stone formation, in particular in obese individuals undergoing rapid weight loss through dietary caloric restriction or weight loss surgery. In those undergoing surgery, UDCA has only been shown to be effective when used preoperatively.[70]Stokes CS, Gluud LL, Casper M, et al. Ursodeoxycholic acid and diets higher in fat prevent gallbladder stones during weight loss: a meta-analysis of randomized controlled trials. Clin Gastroenterol Hepatol. 2014 Jul;12(7):1090-100.e2
https://www.cghjournal.org/article/S1542-3565%2813%2901837-5/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/24321208?tool=bestpractice.com
[71]Haal S, Guman MSS, Boerlage TCC, et al. Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery (UPGRADE): a multicentre, double-blind, randomised, placebo-controlled superiority trial. Lancet Gastroenterol Hepatol. 2021 Dec;6(12):993-1001.
http://www.ncbi.nlm.nih.gov/pubmed/34715031?tool=bestpractice.com
In this setting, UDCA should only be used until weight has stabilised, as the evidence for its efficacy is limited.[1]European Association for the Study of the Liver (EASL). EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016 Jul;65(1):146-81.
https://www.journal-of-hepatology.eu/article/S0168-8278(16)30032-0/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/27085810?tool=bestpractice.com
[71]Haal S, Guman MSS, Boerlage TCC, et al. Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery (UPGRADE): a multicentre, double-blind, randomised, placebo-controlled superiority trial. Lancet Gastroenterol Hepatol. 2021 Dec;6(12):993-1001.
http://www.ncbi.nlm.nih.gov/pubmed/34715031?tool=bestpractice.com
UDCA has limited value for dissolving established gallstones and is not recommended for any other patient groups.[72]Venneman NG, Besselink MG, Keulemans YC, et al. Ursodeoxycholic acid exerts no beneficial effect in patients with symptomatic gallstones awaiting cholecystectomy. Hepatology. 2006 Jun;43(6):1276-83.
http://www.ncbi.nlm.nih.gov/pubmed/16729326?tool=bestpractice.com