A study of 43,141 Swedish twins with gallstone disease found that about 25 percent of the risk of gallstone disease was genetically determined.33 Mutations in some genes may be responsible for the formation of gallstones.7, 8, 44 ABCB4 (encoding the hepatobiliary flippase) gene mutation has been confirmed to be the main genetic risk factor for gallstone recurrence.72 The ABCB4 gene is involved in encoding multi-drug resistance protein 3 (MDR3) of the hepatcholine transporter, and MDR3 damage leads to reduced levels of phosphatidylcholine and promoting the formation of stony bile. Here, ABCB4 is linked to gallstones.