CONDITIONS

What Is Gallstones

Gallstones, also known as choleliths, are hardened, pockets of solidified digestive fluid that can form inside the gallbladder, an organ located in the right side of your abdomen, right below the liver. They can be as small as a single grain of sand, or so large they’re golf-ball-sized. (The world’s largest recorded gallbladder stone was the size of a bowling ball!)

About 90% of the time, gallstones cause no symptoms. But when they do, they can cause the gallbladder to become inflamed or create blockage in a duct, and the effects can be so severe that they must be surgically removed. Symptoms include a pain in the upper right or center of your abdomen beneath your breastbone that seems to strike out of nowhere and rapidly worsens, or an ache that occurs even higher, in your right shoulder or your upper back between your shoulder blades. These attacks may last anywhere from just a few minutes to several hours before fading again. Gallstones may also cause infections that are dangerous or life threatening.


Basic gallstone statistics and trends 

About 12% of Americans—30 million in all—have gallstones. More than 750,000 gallstone-removal treatments are performed in the U.S. annually, at a cost of $8 to $10 billion dollars. Gallstones are thought to stem from a combination of genetics and environmental causes, though scientists aren’t exactly sure. Certain factors can increase your likelihood of developing gallstones:

  • Your sex. Women have a greater chance of gallstone trouble—by age 60, about a quarter of them have gallstones; the incidence hits 50% by age 75. (By contrast, only 20% of men have gallstones by 75.)
  • Your diet, especially fat intake, can also influence gallstone production: Americans of Hispanic and Northern European descent typically develop gallstones more often than people with Asian or African ancestry. Diets high in cholesterol and low in fiber may also encourage gallstones.
  • Family history. Up to a third of all painful cases are thought to stem at least in part from a person’s genetic makeup.
  • Where you live. People in wealthy countries are more likely to get gallstones (probably due to their diet).
  • Being obese or overweight
  • Having diabetes
  • Losing weight rapidly
  • Taking certain kinds of medications that lower cholesterol
  • Taking medications that contain estrogen
  • Having a bone marrow or solid organ transplant

Main types of gallstones

Most gallstones fall into one of two categories:

  • Cholesterol stones. The gallbladder stores a digestive fluid produced by the liver, called bile. Though its makeup includes just 5% cholesterol, about 75% of all gallstones are made of cholesterol that has hardened.
  • Pigment stones make almost the entire remainder of gallstones. These are made from another bile component called calcium bilirubinate, a chemical that’s formed as your body breaks down red blood cells. There are two types of pigment stones:
    • Black pigment stones form in the gallbladder and account for 20% of all gallstones in the U.S. They’re more common in people with cirrhosis (liver scarring) or hemolytic anemia, a blood disorder that causes red blood cells to break down abnormally fast.
    • Brown pigment stones contain higher levels of calcium and cholesterol, and are thought to stem from infection. They’re more common in people of Asian ancestry and are more likely to form in the bile ducts, tubes that carry bile from the liver to the small intestine.
    • Mixed stones are a combination of pigment and cholesterol stones.

What Causes Gallstones

Doctors and researchers aren’t exactly sure why some people develop gallstones. But they think gallstones may result from these problems:

  • Too much cholesterol in your bile. Normally, your liver—the organ directly above the gallbladder—excretes cholesterol, which is then dissolved by your bile, a digestive fluid. But if the amount of cholesterol excreted is more than the chemicals in your bile can dissolve, the unprocessed cholesterol may first form crystals, then gradually harden into gallstones.
  • Your bile contains abnormally high amounts of bilirubin, a chemical produced as your body breaks down red blood cells. This can occur because of conditions such as liver cirrhosis (scarring), infections of the biliary tract (the vessels that conduct secretions from your liver, pancreas and gallbladder into your small intestines), and some types of blood disorders.
  • Your gallbladder, which typically stores digestive fluid, isn’t emptying normally. This can cause your bile to become very concentrated, which raises the chances of gallstone formation.

Risk Factors For Gallstones

Several factors can influence the risk of developing gallstones, including:

  • Age. People 60 or older are more likely to develop them.
  • Sex. Women develop gallstones more often than men.
  • Ethnicity. Native Americans and Mexican-Americans are at elevated risk.
  • Weight. Being overweight or obese makes gallstones more likely.
  • Pregnancy.
  • Diet. A diet that’s high in fat can encourage gallstone formation, as can one that’s high in cholesterol and/or low in fiber.
  • Diabetes has been linked to elevated gallstone risk.
  • Pregnancy can cause bodily changes that lead to gallstones.
  • Rapid weight loss can also create body shifts that leave people more susceptible to gallstone formation.
  • Medications that contain estrogen, or which lower cholesterol, have been known to raise gallstone risk.

Diagnosing Gallstones

Physicians use one or more of the following procedures and tests to determine if someone has gallstones:

  • Gallbladder imaging. Your doctor may order to you to get an ultrasound or computerized tomography (CT) scan of your abdomen. These tests can create a picture of your gallbladder, which in turn can be scrutinized for the presence of gallstones.
  • Scans and imaging of your bile duct to see whether a gallstone is blocking it. These tests go by various names, including HIDA scan (hepatobiliary iminodiacetic acid scan), MRI (magnetic resonance imaging), and ERCP (endoscopic retrograde cholangiopancreatography).
  • Blood tests to check for signs that you are suffering from complications of gallstones.

Symptoms of Gallstones

Gallstones don’t always cause symptoms, but can cause discomfort if they form a blockage within a duct. Symptoms include:

  • Pain in your upper right or upper middle abdomen that lasts at least half an hour. It can feel sharp or dull, and be constant or come in cramps.
  • Pain in the middle of your abdomen, just under your breastbone
  • Pain in your back, in the area between your shoulder blades
  • Pain located in your right shoulder
  • Fever
  • Jaundice (a yellowing of the whites of your eyes as well as of your skin)
  • Bowel movements that resemble clay in their color.

Prognosis

After your gallstones are removed, you may need to follow a liquid diet for a period of time, so your gallbladder can rest and heal. Fortunately, almost all people who have gallstones surgically removed do not suffer a recurrence, and the chance of post-surgical complications is very low. Of these rare complications, the most frequent are infections of the gallbladder or pancreas, or of the tube that carries bile from the liver to the gallbladder and intestines.

Living With Gallstones

If you wish to avoid surgery and testing shows that your gallstones are relatively small, there is a nonsurgical option to explore: With your doctor’s permission, you can take ursodiol, an acid that occurs naturally in the bile and which helps to dissolve cholesterol. Its drawbacks are that it is slow acting—it may take as long as two years to work—and that it is effective only on gallstones that are composed of cholesterol.

Screening

Physicians generally do not screen healthy patients for the possibility of gallstones. But if your doctor recognizes several symptoms of gallstones, he or she will most likely conduct diagnostic tests to determine whether or not you have them.

Prevention

While there are no ways to guarantee against getting gallstones, these steps will reduce your chances of developing them:

  • Keep your weight within healthy limits. Being overweight or obese will raise your risk of gallstones
  • If you need to lose weight, do it slowly—aim for 1-2 pounds weekly. Any more, and you will increase your chances of gallstone formation.
  • Eat on a regular schedule. Fasting or skipping meals can make gallstones more likely.

Medication And Treatment

Surgical treatment for gallstones: When gallstones are painful or causing blockages, doctors will most commonly recommend surgically removing the gallbladder, a procedure called cholecystectomy. Fortunately, the gallbladder is not an essential organ. After it’s removed, bile—the digestive fluid that’s produced by the liver and then stored in the gallbladder—simply flows directly into the small intestine. People who’ve had their gallbladder removed typically continue to digest food as before, although they may temporarily suffer from bouts of diarrhea.

Complementary and Alternative Treatment

While there is an alternative treatment for gallstones, a procedure called a gallbladder cleanse (or a gallbladder flush or liver flush), it is not scientifically endorsed. Generally, a gallbladder cleanse consists of drinking or eating olive oil, fruit juice, and herbs for two or more days (often to the exclusion of all other foods). Research has shown no proof that gallbladder cleanses break up gallstones, however, and they may have side effects, including nausea, abdominal pain, vomiting, and diarrhea. The herbs used may have unwelcome or hazardous side effects as well.

When To Contact A Doctor

If you think you may have gallstones, or are experiencing any of the symptoms of gallstones, schedule an appointment with your physician. He or she will be able to conduct or order tests to determine if gallstones are the cause of your discomfort. Seek immediate care for any of these symptoms, which could indicate you’re at risk of severe complications from gallstones:

  • Yellowing of the whites of the eyes or of your skin, which is referred to as jaundice
  • Chills and high fever
  • Pain in your abdomen that is so severe you can’t find a comfortable position or are unable to sit still

If you suspect you have gallstones, make an appointment with your primary care physician, or a general practitioner. If her examination suggests you are suffering from gallstones, she may refer you to a gastroenterologist—a physician specializing in problems with the digestive system. You may also be referred to an abdominal surgeon. If you need to find a gastroenterologist on your own, visit the “Find a Gastroenterologist” page on the website of the American College of Gastroenterology.

To find out if a gastroenterologist you are considering is board certified, visit the “Is Your Doctor Board Certified” of the American Board of Medical Specialties.

Questions For A Doctor

If you think you may be suffering from gallstones, make an appointment to see your physician. You will probably find it helpful to ask the following questions:

  • What are the chances that gallstones are causing my discomfort?
  •  Do you need to perform any tests to confirm or rule out that I have gallstones?
  • What are the chances that something else is causing my pain?
  • Is there a possibility that my gallstones will go away on their own?
  • Do I require surgery? What are the possible complications?
  • How long would it take to recover from the surgery?
  • Do I need to see a specialist?
  • Are there any alternative treatments I should try/
  • How can I best manage my gallstones along with any other chronic conditions I have?
  • Do you have any printed materials on gallstones, or any websites you could recommend?

RESOURCES:

For more information on gallstones, visit:

For updates on gallstone research, visit:

To learn about ongoing and upcoming clinical trials at safe and effective ways to prevent, diagnose, or treat gallstones, visit: