Guard against gallstones

What are gallstones?

Bile, made by the liver and stored in the gallbladder, helps digest fats. When bile contains too much cholesterol or pigment, or the gallbladder does not empty well, crystals form and slowly grow into stones. They can be as small as a grain of sand or as large as a golf ball, single or many.

Gallstones are very common in India, particularly in the north, and are one of the most frequent reasons for abdominal surgery.

Who is more likely to get them?

• Women, especially after pregnancy or on hormone therapy
• People over 40
• Overweight and obesity — and, equally, rapid weight loss or crash dieting
• Diabetes and high blood fats
• A family history of gallstones
• Long periods of fasting or skipped meals

Symptoms: gallstone pain and indigestion

Many people have "silent" stones found by chance on an ultrasound. When stones cause symptoms, the typical pattern — called biliary colic — is:

• Pain in the upper right or upper middle abdomen, often after a heavy or fatty meal or at night
• Pain that builds up, stays steady for 30 minutes to several hours, and may spread to the right shoulder or back
• Nausea or vomiting with the pain
• Repeated gas, belching, bloating and indigestion after meals

Once stones have caused pain, further attacks — and complications — become more likely.

Complications you should not ignore

A stone that moves out of the gallbladder can block the ducts that carry bile and pancreatic juice. Seek care urgently if you have:

• Pain lasting more than a few hours, or with fever and chills — acute cholecystitis or a pus-filled gallbladder (empyema)
• Yellow eyes, dark urine or pale stools — a stone in the bile duct causing jaundice
• Jaundice with high fever and shivering — cholangitis, an infection of the bile duct that is a medical emergency
• Severe upper abdominal pain going through to the back with vomiting — gallstone pancreatitis

Long-standing stones with repeated inflammation are also associated with a higher risk of gallbladder cancer, which is notably common in north and north-east India. This is one more reason symptomatic stones should be treated rather than tolerated.

How gallstones are diagnosed

An abdominal ultrasound is the standard first test — quick, painless and accurate for stones in the gallbladder. Blood tests (liver function tests, blood count, amylase/lipase) check for infection, jaundice or pancreatitis. If a stone in the bile duct is suspected, an MRCP (a special MRI) or an endoscopic ultrasound (EUS) maps the ducts.

Treatment: laparoscopic gallbladder removal

Medicines, diets and "stone-dissolving" remedies do not reliably remove gallstones, and stones tend to come back while the gallbladder remains. The standard treatment for stones that cause symptoms is laparoscopic cholecystectomy — removal of the gallbladder through a few small incisions using a camera.

• Usually a one- to two-day hospital stay
• Most people return to desk work within a week and normal activity in two to three weeks
• Small scars, less pain and faster recovery than open surgery
• Stones in the bile duct can be removed before or after surgery by ERCP, an endoscopic procedure

People live normal lives without a gallbladder — the liver continues to make bile, which flows directly into the intestine. A few people notice looser stools after fatty meals for some weeks, which usually settles. Silent stones found by chance do not always need surgery; the decision depends on stone size, gallbladder wall changes, diabetes and other risk factors, and is best made with a surgeon.

Lowering your risk

• Keep to a healthy weight and lose weight gradually (about 0.5–1 kg a week), not through crash diets
• Eat regular meals — avoid long fasts and skipped breakfasts
• Choose a fibre-rich diet with vegetables, fruit, whole grains and pulses; limit fried and highly processed foods
• Stay physically active