Management of chronic cholecystitis

In suspected chronic cholecystitis, if the clinical presentation is characteristic of gallbladder disease then no special investigations are necessary apart from ultrasonography to confirm the presence of gallstones. A less clear-cut presentation may necessitate more extensive investigation, e.g. upper GI endoscopy, serum amylase, etc.

The treatment of choice is a cholecystectomy. Patients are often put on a low fat diet prior to the operation. This may have two effects: relief of symptoms - presumably because of removal of stimulus of gallbladder contraction - and, if necessary, facilitation of weight loss.

Note - patients who are not surgical candidates or who prefer not to undergo surgery can be closely observed and managed conservatively. In patients with symptomatic cholelithiasis, the use of ursodeoxycholic acid has been shown to decrease rates of biliary colic and acute cholecystitis although the evidence on its role in chronic cholecystitis is limited. (2)

Reference

1. Elwood DR. Cholecystitis. Surg Clin North Am. 2008;88(6):1241-52
2. Guarino MP et al. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World J Gastroenterol. 2013 Aug 21;19(31):5029-34.