Gallstones Symptoms, Treatments and Prevention

Women Face Significantly Greater Risk for Gallstones

Illustration of gallstones in the gallbladder (with the liver and pancreas)

Gallstones are the most common and costly digestive disease in the United States, causing more than 800,000 hospitalizations annually at estimated cost of over five billion dollars. More than 20 million Americans have gallstones and approximately one million new cases are diagnosed each year. Women are twice as likely as men to develop gallstones; the higher prevalence of gallstones in women is thought to be caused by multiple pregnancies, obesity, and rapid weight loss.

Well over half a million people undergo cholecystectomy (surgical removal of the gallbladder) each year.

The normal function of the gallbladder is to store bile produced by the liver and to aid in the digestion and absorption of fats in the duodenum (the first portion of the small intestine). Gallstones compose a solid formation of cholesterol and bile salts. However, research shows that approximately 80 to 90 percent of all gallstones are cholesterol gallstones which form when the liver begins secreting bile that is abnormally saturated with cholesterol. The excess cholesterol crystallizes and then forms stones which are stored in the gallbladder or the cystic duct. Gallstones can also form due to low levels of bile acids and bile lecithin.

Who Is At Risk For Gallstones?

When I was diagnosed with gallstones at 26, I was told that the typical gallstone patient was fair, fat, and forty. Today gallstones are seen in younger patients, perhaps due to the large amount of fast foods being consumed.

My daughter went through five years of vomiting beginning at age 15, leading me to almost believe that she was bulimic before she was diagnosed with gallstones at age 20. Risk factors which can lead to increased incidence of gallstones include the "Four Fs:" fat, female, fertile, and flatulent, as well as sickle cell disease (bilirubin), cirrhosis, Crohn's disease, diabetes, pancreatic disease, and hyperparathyroidism.

Symptoms of Gallstones

When the symptoms of gallstones occur they are often called an "attack" because they occur suddenly. The typical gallstone attack includes:

  • Steady, severe pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours.
  • Pain in the back between the shoulder blades.
  • Pain under the right shoulder.
  • Nausea or vomiting.

Gallstone attacks often follow fatty meals, and they may occur during the night. Although I was lucky not to have too much nausea and vomiting with my gallstones, one of my most vivid childhood memories is of my mother up at night, in the bathroom, vomiting.

Other symptoms of gallstones include:

The following symptoms are indication that you should seek immediate medical attention:

  • Sweating.
  • Chills.
  • Low-grade fever.
  • Yellowish color of the skin or whites of the eyes.
  • Clay-colored stools.

Many people have gallstones with no symptoms, these people are called asymptomatic. Gallstones that cause no symptoms are called "silent stones." Silent stones do not interfere in gallbladder, liver, or pancreas function and do not require treatment.

Treatment for Gallstones - Traditional and Alternative

Until just a few years ago, the most common treatment for symptomatic gallstones was a surgical procedure called cholecystectomy which required a large abdominal incision to remove the gallbladder.

This was an extremely painful (based on my personal experience) and difficult to recover from operation that required at least five days in the hospital, and approximately six weeks for recovery.

Today laparoscopic cholecystectomy is most commonly performed. Laparoscopic cholecystectomy is usually performed in a day surgery unit and requires only a tiny incision. My daughter's gallstones were treated laparoscopically, leaving her feeling well enough to continue her normal activities later that day. However, it should be noted that not all patients will recover almost instantaneously as my daughter did--the typical patient may need up to a week to recover before returning to normal activities.

Alternative treatments for gallstones include:

  • Oral bile acid dissolution therapy.
  • Contact solvent dissolution.
  • Mechanical extraction through a catheter placed into the gallbladder either through the skin or through and endoscope.
  • Fragmentation through shock-wave lithotripsy combined with bile acid dissolution.

Each of these alternative treatments leave the gallbladder in place. Because the gallbladder is not removed during these treatments many patients face a significant risk of recurrence.

Gallstone Prevention

People who may be at risk for developing gallstones may want to try modifying their diet to decrease their risk. The amount of dietary fiber consumed is an important therapy for gallstones that is often overlooked. Gallstones may be prevented by increasing consumption of both soluble and insoluble fiber which reduces the absorption of deoxycholic acid by producing a favorable shift in the triad of factors that control cholesterol's solubility in bile. Soluble fibers which are effective include guar gum and pectin, as well as other types of fiber (including oat bran, wheat bran, and soy fiber) which are found in many fruits and vegetables. The benefit of fiber is seen in the low incidence of gallstones in vegetarians.

Coffee drinking has been associated with a decreased risk of symptomatic gallstones, according to research conducted by the Harvard School of Public Health and published in the June 9, 1999, issue of the Journal of the American Medical Association. The study found that men (over 46,000 men were studied) who drank two or three cups of coffee a day had a 40 percent lower risk of developing gallstones, while men who drank 4 or more cups of coffee a day decreased their risk by 45 percent. The study found no relation between gallstone prevention and tea, decaffeinated coffee, or caffeinated soft drinks.

Regular, vigorous, exercise may decrease the risk of gallstones. One study, reported by WebMD, found that men who performed endurance activities such as jogging, running, racquet sports, and brisk walking for 30 minutes five times a week, experienced a 34 percent reduction in risk for gallbladder disease. The amount of benefit derived from exercise was more dependent on intensity than type of exercise. Researchers theorize that exercise helps to normalize blood sugar and insulin levels which may contribute to gallstones, if abnormal.

There is also some research which suggests that taking nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin or ibuprofen offers some protection against the formation of gallstones. However, one study found no difference in the risk of gallstones in over 400 chronic arthritis patients who regularly took NSAIDS.

Another option, approved by the FDA for obese patients, is a drug called Actigall®. This is the first drug approved for the prevention of gallstones; it has been used in carefully selected patients since 1988.