How Celiac Disease May Affect Your Risk for Gallbladder Disease

People with celiac disease often report gallbladder problems.

woman talking to doctor
Terry Vine / Getty Images

It's not unusual for people with celiac disease to report having problems with their gallbladders. As it turns out, the link between celiac and gallbladder issues may not be just an anecdotal one: several studies have linked celiac disease and certain types of gallbladder disease.

However, there's some debate over whether people with celiac actually are at higher risk for the most common type of gallbladder disease: gallstones.

This common and painful digestive condition does affect many people who also have celiac disease, but there isn't much evidence indicating that people with celiac are at any higher risk for gallstones than people who don't have celiac disease.

Still, some researchers have hypothesized that the type of intestinal damage that occurs in those with celiac disease could lead to a so-called "sluggish gallbladder," which in turn could lead to the formation of a certain type of gallstones.

Read on for the details of how celiac disease potentially may affect your gallbladder, and for your risks of developing gallbladder disease.

How Your Gallbladder Assists in Digestion

Your gallbladder is a small, pear-shaped organ located just under your liver on your right hand side, below your rib cage. It's basically a storage container: its purpose is to collect digestive enzymes called bile (or alternatively, gall—hence the name "gallbladder") from your liver and hold those enzymes until they're needed to help you digest food.

Then, your gallbladder contracts and releases the stored enzymes into your small intestine, where the actual digestion occurs.

When your gallbladder functions properly, you won't be aware of it doing its job. But, unfortunately, there are several ways your gallbladder can malfunction and cause problems.

Common Gallbladder Problems

The most common problem people experience with their gallbladder is the development of gallstones. In some people, small "stones" form in the bile, and those can cause significant pain and inflammation. It's not clear why this happens, but possible reasons include too much cholesterol in your bile or too much bilirubin (a yellow chemical produced by your body when it breaks down red blood cells) in your bile.

There are two different types of gallstones: cholesterol gallstones, which are the most common, and pigment gallstones, which are less common and develop when your bile contains too much bilirubin. You also may develop gallstones when your gallbladder doesn't empty properly.

Not everyone who has gallstones has symptoms. But symptoms of gallstones can include: severe pain in your upper right abdomen that can migrate to your shoulder and upper right back, nausea, and vomiting. The symptoms may last only a few minutes or may continue for several hours. The bile stored in your gallbladder helps you digest the fat in your diet, and so you might have such an "attack" following an especially rich or fatty meal as your gallbladder attempts to contract.

If you have gallstones—especially if your gallstones are blocking the duct where bile empties into your small intestine—your gallbladder may become inflamed.

This condition is known as cholecystitis. Symptoms of cholecystitis include: pain (often severe) on the right side of your abdomen, just below your rib cage, nausea and vomiting, and fever. Most often, you'll experience these symptoms within an hour or two following a large meal. Meals that contain a lot of fat can trigger symptoms of cholecystitis.

Severe cholecystitis can lead to a bad infection in your gallbladder and can even cause your gallbladder to tear or burst. If your doctor diagnoses you with the condition, you'll need antibiotics to control the infection, and you may even need to be hospitalized.

If you suffer more than one bout of cholecystitis, your doctor will describe your options. Many people who have recurrent cholecystitis require removal of their gallbladder.

How Celiac Disease May Be Linked to Gallbladder Disease

Celiac disease causes the lining of your small intestine to erode in a process called villous atrophy. But you probably know that celiac disease affects far more than just your digestive tract: celiac symptoms can impact your nervous system, your fertility, your joints, and even your skin.

Since celiac's impacts are so wide-ranging, it's not surprising that the condition could be linked to gallbladder issues. In fact, it's fairly common for people with celiac disease to say they had their gallbladder removed either before or after diagnosis. A few people have said they believe their celiac disease was triggered by gallbladder removal, but it's of course impossible to confirm what may have caused anyone's celiac disease.

Studies in people who have celiac disease but who aren't following the gluten-free diet have found problems with gallbladder emptying following a fatty meal. This problem can make the person more susceptible to developing the type of gallstones made from cholesterol.

Researchers in Italy studied 19 people with celiac disease who were not yet following the gluten-free diet, and found that their gallbladders emptied more slowly than the gallbladders in people without the condition. The researchers then studied gallbladder function in the same people once they had gone gluten-free, and found that gallbladder emptying was normal.

However, that same study also found that food moved more slowly through the small intestines of people with celiac disease than it did in people without the condition regardless of whether the people with celiac were following the gluten-free diet or not.

Some evidence exists that people with celiac disease may have impaired gallbladder function despite following the gluten-free diet.

Does Celiac Increase Your Risk of Gallstones?

Despite the evidence that having celiac disease can impact the function of your gallbladder, the scant research available indicates that people with celiac are not necessarily at significantly higher risk for gallstones. However, some researchers are challenging that view.

A study conducted several decades ago showed that only nine out of 350 people with celiac disease had their gallbladder removed due to gallstones. Meanwhile, a more recent study indicates that people diagnosed with celiac disease after age 60 may be at higher risk for gallstones—some 20 percent of those included in that research had gallstones.

Again more recently, researchers writing in the European Journal of Clinical Investigation hypothesized that celiac disease could be an important risk factor for gallstone formation—specifically, formation of the more common cholesterol gallstones—because celiac disease may lead to lower levels of a hormone your body uses to tell your gallbladder to release bile.

That hormone, known as cholecystokinin, is produced by the lining of the small intestine, which is damaged when you have celiac disease. Less cholecystokinin could mean your gallbladder doesn't work as well as it should—making it a so-called "sluggish gallbladder"—which in turn could lead to the formation of those cholesterol gallstones, the researchers say. However, this theory hasn't yet been backed up by medical research.

Both celiac disease and gallstones are more common in women than men. Women are diagnosed with celiac disease almost twice as often as men. Similarly, women in their fertile years are almost twice as likely to be diagnosed with gallstones as men, although the difference between the genders narrows with older people. However, the fact that celiac and gallstones are more common in women than in men doesn't necessarily mean the two conditions are related. More research is needed to determine whether celiac disease indeed is a risk factor for gallstones.

Connection to Bile Duct Disease

Celiac disease impacts your liver, which is responsible for making the bile stored by your gallbladder. For example, celiac is linked to abnormal liver tests and to a form of liver disease called autoimmune hepatitis, in which your immune system attacks your liver. In several reported cases, a celiac diagnosis and subsequent switch to the gluten-free diet repaired liver damage in people who previously had been candidates for a liver transplant.

Celiac also may be associated with a condition called primary sclerosing cholangitis, which is a chronic condition involving gradual damage to the ducts that move bile from the liver to the gallbladder.

Researchers writing in the World Journal of Gastroenterology say that primary sclerosing cholangitis may share some common genetic factors with celiac disease, which may possibly account for the potential link between the two conditions. However, according to the researchers, there's no evidence that the gluten-free diet can reverse this type of damage to the bile ducts.

A Word From Verywell

Digestion is a complicated process, and your gallbladder plays an important role. However, you don't need your gallbladder, so if your doctor recommends removing it due to gallbladder disease, you shouldn't be concerned about agreeing to the surgery.

A few clinicians recommend that people who are newly diagnosed with celiac disease undergo a test that uses ultrasound to determine whether their gallbladders are working properly, and whether there's so-called "sludge," or the precursor to gallstones, present in the gallbladder. However, not all physicians agree this test is necessary. If you've been diagnosed with gallstones in the past, you may want to consider discussing this with your doctor.

Some people require a temporary, special low-fat diet that's also high in fiber following gallbladder surgery while their digestive systems adjust to not having a gallbladder. If you have celiac disease and are undergoing gallbladder removal, you should talk to your doctor about what foods to eat while recovering. Not all fiber supplements are gluten-free, but many naturally gluten-free foods contain lots of fiber. If you need help planning your meals, ask your physician to refer you to a dietitian who specializes in the gluten-free diet.

Sources:

Benini F et al. Slow Gallbladder Emptying Reverts to Normal but Small Intestinal Transit of a Physiological Meal Remains Slow in Celiac Patients During Gluten-Free Diet. Neurogastroenterology and Motility. 2012 Feb;24(2):100-7, e79-80.

Farnetti S et al. Functional and Metabolic Disorders in Celiac Disease: New Implications for Nutritional Treatment. Journal of Medicinal Food. 2014 Nov;17(11):1159-64.

Freeman HJ. Hepatobiliary and Pancreatic Disorders in Celiac Disease. World Journal of Gastroenterology. 2006 Mar 14; 12(10): 1503–1508.

Wang HH et al. Impaired Intestinal Cholecystokinin Secretion, a Fascinating but Overlooked Link Between Coeliac Disease and Cholesterol Gallstone Disease. European Journal of Clinical Investigation. 2017 Apr;47(4):328-333.

Continue Reading