Gallstones cause no symptoms and no harm, have nothing to do with pain after eating, and the gallbladder should not be removed.
Original statement
حصوات المراره جانبيه على حضرتك هي حصلت وخلاص حصوات بس وانتهت القصه على كده مالهاش اعراض مالهاش اثار جانبيه عليك مالهاش مالهاش وجع مزمن يروح لا مالهاش مالهاش وجع علاقه بالوجع اللي بيجيلك في الحته دي وبعد الاكل
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
Gallstones cause no symptoms and no harm, have nothing to do with pain after eating, and the gallbladder should not be removed.
Origin
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! (Open source)
- Published
- 27 August 2025
- Timestamp
- 1:14:08 (location in the original video’s automatic YouTube caption track; confirms where the words occur, not who speaks)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
- Claimed mechanism
Symptoms come from wrong food and bowel obstruction, not stones.
- Claimed health effect
No harm from gallstones.
- Population concerned
People with gallstones
- Geographic restriction by Elawady
none found
Diverging source versions
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live!عرق النسا (Open source)
- Published
- 28 December 2025
- Timestamp
- not available (transcript has no timings)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
Scientific assessment
Mostly false – Essential parts of the statement are not supported by the evidence or are strongly exaggerated.
Certainty of evidence: moderate – Further research may still affect the assessment.
1. What was claimed?
Gallstones are harmless and cause no symptoms.
2. What is demonstrably correct?
Partly correct: about 80% of gallstones remain asymptomatic (C-GALL background, I-ORG-09), and asymptomatic stones are generally not operated; for uncomplicated symptomatic stones, observation was not worse on general pain scores at 18 months (I-ORG-09).
3. What is wrong or exaggerated?
Wrong as a general statement: in C-GALL (I-ORG-09), 25 of 217 patients (11.5%) under observation had complications before surgery (mainly cholecystitis and biliary colic, also pancreatitis, bile-duct stones and jaundice), 29.5% needed surgery within 24 months, and gallstone-specific quality of life was better after cholecystectomy (difference 9.0).
4. What remains unclear?
Long-term outcomes of conservative management.
5. Which studies support it?
I-ORG-09 (partial).
6. Which studies contradict it?
7. What applies to Germany and Europe?
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
8. What is known about Egypt?
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
9. What practical conclusion is appropriate?
Silent stones usually need no surgery; recurrent biliary pain or complications usually do.
Assessment details
- Rationale for certainty of evidence
Most gallstones are indeed silent, but symptomatic gallstone disease and its complications are well documented; RCT shows benefit of surgery on gallstone-specific outcomes.
- Source quality
Transcript statement; contradicts standard medical knowledge for symptomatic disease.
- Regional transferability
Applicable.
- Individual exceptions
About 80% of gallstones remain asymptomatic and generally do not need surgery.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Scientifically refuted – High-quality evidence shows the opposite, or the claim contradicts well-established physiology.
Research question: In adults with gallstones, do gallstones cause symptoms (including post-prandial biliary pain) and complications, and is cholecystectomy beneficial in symptomatic or complicated disease?
Research question in detail (PECO)
- Population
- Adults with incidental or symptomatic gallstones
- Intervention or exposure
- Gallstones left untreated
- Comparison
- Cholecystectomy / no gallstones
- Geographic scope
- universal biology
- Outcomes
- Development of symptoms
- Complications (cholecystitis, pancreatitis, cholangitis)
- Pain after cholecystectomy
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
How often silent gallstones start causing problems
Alzoubi M et al.. PLoS One 2026 · PMID 41886405 · DOI 10.1371/journal.pone.0345462 Meta-analysisabstract checkednewly addedMeta-analysis: most incidental gallstones stay silent; about 10% become symptomatic within 5 years.
- Actual result
- Cumulative symptomatic progression 0.10 (5 y), 0.19 (10 y), 0.26 (15 y).
- Methodological quality
- moderate (MA of 8 cohorts)
- Relevance
- direct for 'most stones are silent'
- Limitations
- Also shows that a minority do become symptomatic.
Fewer gallbladder operations by stricter selection
Comes DJ et al.. JAMA Surg 2024 · PMID 39167382 · DOI 10.1001/jamasurg.2024.3080 Randomised controlled trialfull text checkednewly addedSECURE RCT: about one third of patients still had pain after cholecystectomy, so not all abdominal pain in people with stones comes from the stones.
- Actual result
- Pain-free after cholecystectomy 63.6% / 63.0%.
- Methodological quality
- high (RCT, full text)
- Relevance
- direct for the 'pain' part
- Limitations
- Does not show gallstones never cause pain.
What speaks against the claim?
How often silent gallstones start causing problems
Alzoubi M et al.. PLoS One 2026 · PMID 41886405 · DOI 10.1371/journal.pone.0345462 Meta-analysisabstract checkednewly addedThe same meta-analysis shows a substantial minority develop symptoms over time.
- Actual result
- 26% at 15 years.
- Methodological quality
- moderate
- Relevance
- direct
- Limitations
- Observational.
UK trial: remove the gallbladder or wait?
Innes K et al.. Health Technol Assess 2024 · PMID 38943314 · DOI 10.3310/MNBY3104 Randomised controlled trialfull text, structured risk-of-bias assessmentC-GALL RCT: under conservative management 11.5% had gallstone complications before surgery and 29.5% needed surgery within 24 months.
- Actual result
- Pre-surgery complications 11.5% vs 5.1%.
- Methodological quality
- high (RCT, full text)
- Relevance
- direct
- Limitations
- Uncomplicated symptomatic disease only.
UK guideline on gallstones
National Institute for Health and Care Excellence (NICE). NICE guideline 2014 Guideline / position statementfull text checkednewly addedNICE: symptomatic gallstones and acute cholecystitis should be offered cholecystectomy.
- Actual result
- Recommendations 1.2.2 and 1.2.4.
- Methodological quality
- high (national guideline)
- Relevance
- direct
- Limitations
- 2014.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
Most gallstones are silent and need no treatment (correct part), but gallstones do cause biliary pain and complications in a minority (about 2% per year develop symptoms), and these complications can be dangerous.
Why some studies weigh more
Natural-history meta-analysis and RCTs are direct; guidelines summarise consistent evidence.
Is a causal relationship established? Yes, established Gallstone complications (cholecystitis, biliary pancreatitis, cholangitis) are causally linked to stones by pathophysiology and clinical evidence.
Remaining uncertainty
Which patients with uncomplicated symptoms benefit most from surgery.
Justified conclusion
The claim that gallstones never cause symptoms or harm is false; leaving silent stones alone is correct; symptomatic or complicated stones need medical care.
Why do studies seem to disagree?
SECURE and C-GALL show that some pain attributed to gallstones persists after surgery and that observation is reasonable for some, which does not conflict with the natural-history data showing that stones do cause symptoms and complications in a minority.
Does this depend on the country?
- General biological effects
- Universal.
- Eating habits
- Diet affects gallstone formation risk but was not tested here.
- Origin of the food
- Not applicable.
- Contaminants
- Not applicable.
- National production conditions
- Not applicable.
- Legal rules
- Not applicable.
- Actual monitoring data
- No Egyptian natural-history data found; Arab-region search returned only Saudi studies of special groups (sickle cell, bariatric).
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- Convert cumulative incidence to annual risk – About 2.0-2.1% per year (consistent with Cochrane's 2-4% per year) recalculated
- Recalculate pain-free difference and operation-rate difference – -1.6 points (95% CI -8.7 to 5.5); operations -8.4 points recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Gallstones causing symptoms/complications
- Starting level
- low (observational studies)
- Reasons for upgrading
- large effect / consistent across cohorts and trials
- Result
- moderate
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- NICE: Gallstone disease: diagnosis and management (CG188), Recommendations (2014) · Original publication
Reassure people with asymptomatic gallbladder stones that they need no treatment unless symptoms develop; offer laparoscopic cholecystectomy for symptomatic gallbladder stones; early cholecystectomy within 1 week for acute cholecystitis; bile duct clearance plus cholecystectomy for common bile duct stones (I-ORG-141). - Tokyo Guidelines (TG18): Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis (2018) · Original publication
Abstract: early laparoscopic cholecystectomy recommended for Grade I and (with experienced surgeons) Grade II acute cholecystitis in fit patients; for patients unsuitable for early surgery, early/urgent biliary drainage followed by delayed cholecystectomy. Erratum published 2019. - EASL: EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones (2016) · Original publication could not be retrieved; content not used
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| Europe PMC | 26 October 2026 | (TITLE:"asymptomatic gallstones" OR TITLE:"incidental gallstones" OR TITLE:"silent gallstones" OR TITLE:"natural history" ) AND (gallstones OR cholelithiasis) AND (cohort OR prospective) | both directions | 61 | |
| PubMed | 26 October 2026 | gallstones[ti] AND (natural history OR complications) AND (cohort OR prospective) AND asymptomatic | both directions | 32 | |
| Europe PMC | 26 October 2026 | (TITLE:gallstones OR TITLE:cholelithiasis OR TITLE:cholecystectomy) AND (TITLE:randomised OR TITLE:randomized) AND (conservative OR observation OR restrictive OR "watchful waiting") | supporting evidence | 201 | |
| PubMed | 26 October 2026 | (cholecystectomy[ti]) AND (conservative management[tiab] OR watchful waiting[tiab] OR observation[tiab]) AND (systematic review[pt] OR meta-analysis[pt]) | both directions | 11 | |
| PubMed | 26 October 2026 | (gallstones[ti] OR cholelithiasis[ti]) AND (Egypt[tiab] OR Egyptian[tiab] OR Saudi[tiab] OR Arab[tiab]) AND (prevalence OR complications) | both directions | 19 | |
| PubMed | 26 October 2026 | "EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones" | guidelines | 1 | |
| PubMed | 26 October 2026 | Tokyo Guidelines 2018 flowchart management acute cholecystitis | guidelines | 3 |
Open questions
Patient selection for cholecystectomy in uncomplicated disease.
How deeply was this checked?
4 linked studies: 3 checked in full text (1 of them with a structured risk-of-bias assessment), 1 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Mostly false (moderate)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: Mostly false (moderate)
Unchanged (“Mostly false”, moderate). New evidence confirms both the correct part (most stones are silent; some post-operative pain is not from stones) and the false part (stones cause symptoms and complications in a minority).
New sources: I-ORG-104 I-ORG-105 I-ORG-141
In plain language
Elawady said gallstones cause no symptoms and have nothing to do with pain after meals. It is true that most gallstones never cause problems and are usually left alone. But some gallstones do cause pain attacks and complications. In a UK trial, about 3 in 10 people who tried to avoid surgery needed it within two years, and gallstone-related quality of life was better after surgery.
Studies on this claim
Studies supporting the claim (0)
No studies in this group.
Studies contradicting or limiting the claim (1)
-
UK trial: remove the gallbladder or wait?
Innes K et al.. Health Technol Assess 2024 · PMID 38943314 · DOI 10.3310/MNBY3104Randomised controlled trialindependent cross-checkfull text, structured risk-of-bias assessment★ key studyOver 18 months general pain scores were similar, but about 30% of the 'wait' group needed surgery, 11.5% had gallstone complications before surgery, and gallstone-specific quality of life was better after surgery.
Gallstones cause no symptoms and no harm, have nothing to do with pain after eating, and the gallbladder should not be removed.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Gallstone management
- How was the study done?
RCT
- How many people, animals or samples were studied?
434
- What was actually found?
Similar general QoL; better gallstone QoL with surgery
- How large was the observed effect?
Difference 9.0 condition-specific
- What do the results mean in everyday life?
Waiting can be an option, but gallstones do cause symptoms
- What are the study's limitations?
Short follow-up; many crossovers; unblinded; many questionnaires missing later
- What does it say about Elawady's specific claim?
Contradicts 'gallstones cause no symptoms'
- Do the results apply to Germany and Europe?
European
- What can explicitly not be concluded from this study?
Long-term outcomes
No study in this group is marked as key.
Studies with mixed or unclear results (3)
-
Fewer gallbladder operations by stricter selection
Comes DJ et al.. JAMA Surg 2024 · PMID 39167382 · DOI 10.1001/jamasurg.2024.3080Randomised controlled trialindependent cross-checkfull text checked★ key studyA stricter selection avoided about 8 in 100 operations without more complications, but about a third of patients still had pain after surgery in both groups.
About one third still had pain after removal (not all pain is from stones), but the trial did not test non-treatment and complications occurred in both arms.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Test whether stricter selection for gallbladder surgery is safe in the long term
- How was the study done?
Randomised trial with 5-year follow-up
- How many people, animals or samples were studied?
1067 Dutch adults with gallstones and abdominal pain
- What was actually found?
Fewer operations, no more complications; only about two thirds pain free in both groups
- How large was the observed effect?
Operation rate 73.2% vs 81.5%
- What do the results mean in everyday life?
Gallstones are not always the cause of pain; surgery should be well indicated
- What are the study's limitations?
Protocol deviations and missing survey data
- What does it say about Elawady's specific claim?
Partly supports caution, not a ban on surgery
- Do the results apply to Germany and Europe?
Directly applicable
- What can explicitly not be concluded from this study?
Cannot say that untreated symptomatic gallstones are harmless
-
How often silent gallstones start causing problems
Alzoubi M et al.. PLoS One 2026 · PMID 41886405 · DOI 10.1371/journal.pone.0345462Meta-analysisindependent cross-checkabstract checked★ key studyAbout 10% of people with silent gallstones develop symptoms within 5 years and about 19% within 10 years.
Most stones stay silent (correct part), but about 1 in 5 becomes symptomatic within 10 years (refutes 'no symptoms').
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Estimate how often incidental gallstones become symptomatic
- How was the study done?
Meta-analysis of 8 cohort studies
- How many people, animals or samples were studied?
25,924 adults
- What was actually found?
Symptoms in 10% at 5 y, 19% at 10 y, 26% at 15 y
- How large was the observed effect?
About 2% per year
- What do the results mean in everyday life?
Most silent stones can be left alone, but they can cause symptoms later
- What are the study's limitations?
Observational, heterogeneous studies
- What does it say about Elawady's specific claim?
Partly supports (silent stones usually harmless), partly refutes (they can cause symptoms)
- Do the results apply to Germany and Europe?
Directly applicable
- What can explicitly not be concluded from this study?
Does not test diet
-
UK guideline on gallstones
National Institute for Health and Care Excellence (NICE). NICE guideline 2014Guideline / position statementindependent cross-checkfull text checked★ key studySilent gallstones need no treatment, but people with symptoms or gallbladder inflammation should be offered gallbladder removal.
Silent stones: no treatment (agrees); symptomatic stones/cholecystitis: offer surgery (disagrees).
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Advise on gallstone management
- How was the study done?
National guideline
- How many people, animals or samples were studied?
n/a
- What was actually found?
No treatment for silent stones; surgery for symptomatic disease
- How large was the observed effect?
n/a
- What do the results mean in everyday life?
Silent stones can be left; painful or complicated stones need care
- What are the study's limitations?
Predates newest trials
- What does it say about Elawady's specific claim?
Partly agrees, mostly disagrees
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Not about diet
No study in this group is marked as key.
Regional context
Germany / EU
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
Egypt
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
What applies in my country?
General scientific assessment
Mostly false Most gallstones are silent, but the claim that they never cause symptoms is wrong.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- Laparoscopic cholecystectomy versus conservative management for adults with uncomplicated symptomatic gallstones: the C-GALL RCT.. Innes K et al.. Health Technol Assess 2024 · PMID 38943314 · DOI 10.3310/MNBY3104
- Restrictive Strategy vs Usual Care for Cholecystectomy in Patients With Abdominal Pain and Gallstones: 5-Year Follow-Up of the SECURE Randomized Clinical Trial.. Comes DJ et al.. JAMA Surg 2024 · PMID 39167382 · DOI 10.1001/jamasurg.2024.3080
- Asymptomatic gallstones: Cumulative incidence proportion, incidence rate, and risk factors for symptoms development: Systematic review and meta-analysis.. Alzoubi M et al.. PLoS One 2026 · PMID 41886405 · DOI 10.1371/journal.pone.0345462
- Gallstone disease: diagnosis and management (NICE clinical guideline CG188), Recommendations. National Institute for Health and Care Excellence (NICE). NICE guideline 2014