Embora as evidências de um efeito preventivo sejam fracas, a modificação do estilo de vida continua sendo a base da prevenção primária dos cálculos biliares. As modificações do estilo de vida preventivas recomendadas na prática incluem dieta rica em fibras, proteína, cálcio e vitamina C, baixa em gorduras saturadas, e a manutenção de um peso corporal saudável, combinadas com atividade física moderada.[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
[2]Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012 Apr;6(2):172-87.
http://www.gutnliver.org/journal/view.html?doi=10.5009/gnl.2012.6.2.172
http://www.ncbi.nlm.nih.gov/pubmed/22570746?tool=bestpractice.com
[7]Shaffer EA. Gallstone disease: epidemiology of gallbladder stone disease. Best Prac Res Clin Gastroenterol. 2006;20(6):981-96.
http://www.ncbi.nlm.nih.gov/pubmed/17127183?tool=bestpractice.com
[27]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
[62]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.ncbi.nlm.nih.gov/pmc/articles/PMC6641782
http://www.ncbi.nlm.nih.gov/pubmed/31305451?tool=bestpractice.com
[65]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
[66]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
[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
A terapia medicamentosa preventiva com ácido ursodesoxicólico (AUDC), o qual diminui a saturação de colesterol na bile, pode ser usada para diminuir o risco em curto prazo da formação de cálculos nos indivíduos obesos passando por perda de peso rápida por meio de restrição calórica alimentar ou cirurgia para perda de peso.[69]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
Nos indivíduos submetidos à cirurgia, o AUDC só mostrou ser efetivo quando usado no pré-operatório.[69]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
Nesse cenário, o AUDC só deve ser usado até que o peso do paciente tenha estabilizado, pois as evidências de sua eficácia são limitadas.[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
[70]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
O AUDC tem valor limitado para dissolver os cálculos biliares estabelecidos e não é recomendado para nenhum outro grupo de pacientes.[71]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