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Gallstones develop in the gallbladder or the bile ducts. According to their chemical composition, gallstones can be divided into cholesterol stones, which are common, and the rare bile pigment stones. Altogether, up to 20 % of all adults develop gallstones and more than 20 % of them symptoms or complications. Female sex, age, pregnancy, physical inactivity, obesity, overnutrition and genetic factors such as ABCB4 deficiency of the hepatic lecithin transporter are kown risk factors for gallstone formation. In about one half of all patients biliary symptoms precede the three common and potentially life-threatening complications (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge about the genetics and pathophysiology of gallstones has improved, current treatment algorithms are predominantly invasive (ERC and surgery). Thus, better strategies are needed to prevent the formation of gallstones in general., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

While digital health is changing the way we perform medicine, implementation of novel diagnostic or therapeutic approaches into clinical practice remains challenging. In this paper we discuss strategies and problems that need to be addressed to enable the translation of new technologies. With its broad spectrum of diseases and procedures the field of gastroenterology offers a perfect test bed for digital innovation. Two clusters of excellence funded by the German Research Foundation focus on data driven personalized therapeutic strategies for oncological and autoimmune diseases. On experimental level digital innovations in endoscopy and for ultrasound-guided interventions are being developed. In endoscopy artificial intelligence-driven decision support systems for adenoma detection have been developed that show promising results in clinical trails. However, for future development it will be crucial to follow an interdisciplinary approach with medical professionals and patients guiding the innovation process. Therefore digital health literacy will need to be implemented in medical education. In the academic field a strong cooperation of clinicians, patients, computer scientists and engineers will be essential., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

This short version of the guideline summarizes the evidence-based key recommendations for the prevention, diagnosis and therapy of gallstones and upgrades the 2007 version. The guideline used structural S3 consensus-based methodology and includes statements on clinical management and prevention, medical education, and quality assurance., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: In general practitioner care, abnormal liver chemistries are often being diagnosed unintentionally. So far, there is no evidence-based, structured diagnostic pathway for classifying and evaluating elevated liver enzymes, especially with regard to the early detection of patients at increased risk for liver fibrosis or liver cirrhosis. Accordingly, dealing with elevated liver values which are noticed in the course of a general blood examination is a diagnostic challenge that strongly depends on the doctor's approach., Methods and Participants: In the course of a survey, 391 general practitioners in Rhineland-Palatinate and Saarland were interviewed between March and June 2017. The focus was on behavior and strategies with regard to the clarification of elevated liver values as well as the identification of challenges and training interests. In addition to the descriptive analysis, a factor analysis was performed., Results: The determination of liver values such as γ-GT, AST and ALT is frequently performed in general practitioner care without the existence of any particular cause. There are strongly different clusters of liver values that are being analyzed in the course of a liver function test. In the case of increased liver values, a majority of the physicians surveyed generally prefer a controlled waiting (58 %). Due to the absence of an established diagnosis and treatment pathway, challenges arise in everyday practice which relate to controlled waiting, cooperation with gastroenterological specialists, as well as orientation to predefined laboratory value portfolios., Discussion: In addition to the introduction of an evidence-based diagnosis and treatment pathway, it should be considered to optimize the flow of information between general practitioners and gastroenterological specialists. Last but not least, it would be desirable if more training courses for general practitioners could be offered in this subject area., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Gallstones and their complications are one of most frequent gastroenterological diseases leading to hospital admission in Europe. Cholesterol stones are the most common; except of few patients there is a direct link to lifestyle. Obesity, diabetes and insufficient physical activity represent the major risk factors. Abdominal ultrasound is the gold standard for detection of gallstones. ERCP is indicated only in the therapeutic setting. In case of symptomatic gallbladder stones as well as bile duct stones, cholecystectomy is necessary. Higher age is no contraindication. To avoid further biliary colic episodes and / or additional complications, cholecystectomy should be performed as early as possible. In case of acute cholecystitis, cholecystectomy should be performed within 24 h after admission., (© Georg Thieme Verlag KG Stuttgart · New York.)

History and Admission Findings: A 23-year old female patient is referred to our intensive care unit from another hospital because of progredient neurological deterioration with sopor. One week before, she had experienced non-specific pain in her upper right stomach combined with vomitus and nausea. For two days, she had been treated with ciprofloxacin 2 × 500 mg / d by her primary care physician. Except for appendectomy in childhood, no other diseases were reported. Clinical investigation: Physical examination reveals mild scleral and dermal jaundice. There is tenderness of the upper right abdomen. Initially, no neurological pathological findings are obvious. Laboratory results show an increase of liver aminotransferases, bilirubin, and ammonia. The toxicological screening is negative., Treatment and Course: Hepatic encephalopathy due to acute hepatic failure is diagnosed and detoxification of ammonia with lactulose is started. Transiugular liver biopsy confirms lobular hepatitis with cytolysis. Because of progressive deterioration additional treatment to prevent cerebral oedema is initiated. Consecutively serum osmolality decreases, and ammonia and neurological status normalize., Conclusion: This report illustrates toxic acute liver failure after treatment with ciprofloxacin., (© Georg Thieme Verlag KG Stuttgart · New York.)

This short version of the guidelines summarizes the evidence-based key recommendations for the diagnosis and treatment of gallstones. The guidelines were developed by an interdisciplinary team of gastroenterologists, surgeons, radiologists, geneticists, and patient support groups, under the auspice of the German Society for Gastroenterology and Metabolic Diseases and the German Society for General Surgery and Surgery of the Alimentary Tract. It used structural level 3 consensus-based methodology and includes statements on clinical practice, prevention, quality assurance, outcome analysis, and integration of outpatient and inpatient care for patients with gallstone disease.

Evidence based prevention of cholecystolithiasis. Cholesterol cholelithiasis is one of the most common and expensive gastroenterological diseases. Beside common exogenous risk factors, recent molecular genetic studies have identified genetic risk factors for both cholesterol and pigment stone formation. Examples are low phospholipid-associated cholelithiasis due to mutations of the gene encoding the hepatocanalicular phosphatidylcholine transporter, and pigment stones in association with mutations of the ileal bile salt transporter gene. Evidence-based options for primary prevention of cholecystolithiasis include physical activity, slow weight reduction, regular vitamin C supplementation, and moderate coffee consumption. The ongoing genome projects provide the basis for future epidemiological studies of human gallstone (LITH) genes, which might offer new prospects for individual risk assessment and prevention of gallstones.