Gallstones and Crohn's Disease

Gallstones Can Block The Flow Of Bile, Leading To Other Complications

Gallstones
Gallstones are very common, but not all of them cause symptoms. For people with Crohn's disease in the last section of the small intestine, gallstones are common. Image © PIXOLOGICSTUDIO / SCIENCE PHOTO LIBRARY / Getty Images

Gallstones are a common problem, affecting an estimated 10% of men and 20% of women in the United States. However, many gallstones don't cause any symptoms at all. Others, however, can be painful, block the flow of bile, and cause significant damage to the bile ducts and, in turn, other organs.

For people with Crohn's disease, gallstones are a particular problem, affecting anywhere between 13% and 34% of people who have Crohn's disease in the last section of the small intestine (the terminal ileum).

What Is The Gallbladder?

The gallbladder is a small, pear-shaped organ that is attached to the liver and is where bile is stored. The gallbladder and the ducts that run between it and the liver, pancreas, and small intestine are known as the biliary system. Bile is the liquid that is made in the liver, stored in the gallbladder, and secreted into the small intestine in order to facilitate digestion. The function of bile is to help digest the fats in food.

What Are Gallstones?

Gallstones form when something goes wrong with the production of bile and its movement through the bile ducts and into the small intestine. Most commonly gallstones are a result of too much cholesterol in the bile, and are called cholesterol gallstones. The bile and cholesterol harden into a yellow-green mass that is hard like a stone. The stones can be as small as a grain of sand or as big as an apricot.

A second form of gallstones are pigment gallstones, which are dark in color.

This type of gallstones are usually associated with other medical conditions, such as liver disease (cirrhosis or biliary tract infections) or a blood disorder (such as sickle cell anemia). In some cases, the cause for the gallstones is not known.

For people with Crohn's disease, gallstones may form as a result of the inflammation that the inflammatory bowel disease (IBD) causes.

If there is disease in the terminal ileum, bile salts can not be absorbed there. When bile salts are not absorbed, they will not be able to break down cholesterol. This may lead to the hardening of the bile and cholesterol, forming the stones that block the bile ducts.

Why Are Gallstones A Problem?

When gallstones form, they can cause a blockage in the bile ducts, prohibiting bile from making its way from the liver to the gallbladder and from the gallbladder to the small intestine. Trapped bile could lead to inflammation in those ducts, and potentially even the liver, gallbladder, or pancreas. If the pancreas is involved, a painful condition called gallstone pancreatitis can develop.

Gallstone Risk Factors

Crohn's disease in the terminal ileum is a risk factor for gallstones, but there are several others, including:

  • Age over 60
  • Diabetes
  • Ethnicity, especially Native American and Mexican American
  • Fasting
  • High estrogen levels from pregnancy, hormone replacement therapy, or birth control pills
  • Obesity
  • Rapid weight loss
  • Taking cholesterol-lowering drugs
  • Women are at higher risk than men

Gallstone Symptoms

Symptoms from gallstones can come on suddenly and cause:

  • Pain
    • In the upper abdominal that becomes more intense and could last between 30 minutes and a few hours
    • Between the shoulder blades
    • Under the right shoulder
  • Nausea
  • Vomiting

Aside from the acute symptoms, there can be other symptoms of gallstones such as:

  • Abdominal bloating
  • Belching
  • Colic
  • Gas
  • Indigestion
  • Symptoms after eating fatty foods

How Are Gallstones Treated?

Gallstones can be treated surgically or nonsurgically. Surgery is done most often because with nonsurgical treatments, gallstones tend to recur. However, there could be situations where surgery isn't an option, or must be delayed.

Nonsurgical treatments include oral dissolution therapy, contact dissolution therapy, endoscopic retrograde cholangiopancreatogram (ERCP), extracorporeal shockwave lithotripsy (ESWL), and percutaneous cholecystostomy. Oral dissolution therapy is the use of oral medications to dissolve the stones, and contact dissolution therapy is the injection of medications into the gallbladder to dissolve the stones. With ERCP, a tube is inserted into the throat and down through the stomach to the common bile duct, where it might be possible to remove gallstones. ESWL is the use of ultrasound waves to break up the stones, and is not commonly used. With percutaneous cholecystostomy, the gallbladder is drained via a tube passed through the abdomen.

Can Gallstones Be An Emergency?

Gallstones can lead to serious complications. Some symptoms that should be discussed with a doctor immediately include sweating, chills, fever, jaundice, or clay-colored stools. Anyone with severe abdominal pain accompanied by vomiting or diarrhea should seek medical attention immediately.

How Can You Live Without A Gallbladder?

Most people don't miss their gallbladders, however a very small percentage may experience diarrhea from the increase in bile flowing into the small intestine. In the overwhelming majority of cases, the bile flows directly from the liver through the ducts and into the small intestine, and there are no noticeable changes in digestion.

Source:

Eshuis EJ, Slors JF, Stokkers PC, et al. "Long-term outcomes following laparoscopically assisted versus open ileocolic resection for Crohn's disease." Br J Surg. 2010 Apr;97:563-568. 28 Jan 2016.

Fraquelli M, Losco A, Visentin S, et al. "Gallstone disease and related risk factors in patients with Crohn disease: analysis of 330 consecutive cases." Arch Intern Med. 2001 Oct 8;161:2201-2204. 28 Jan 2016.

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