Brief overview
- What are gallstones? Crystallized components of the bile fluid in the form of tiny stones (semolina) or larger stones. Depending on their location, a distinction is made between gallbladder stones and bile duct stones. Women have gallstones more often than men.
- Risk factors: mainly female, overweight (fat), fertile, 40 years and over (forty), fair-haired (fair), family predisposition (family).
- Possible consequences: Inflammation of the pancreas (acute pancreatitis); injury to the gallbladder wall with leakage of bile into the abdomen and resulting peritonitis; increased risk of gallbladder and bile duct cancer.
- Treatment: surgery, medication, shock wave therapy.
Gallstones: Description
The main component of bile is water, which accounts for about 80 percent. It also contains bile acids, proteins and bilirubin (a yellowish breakdown product of the red blood pigment hemoglobin). Bile also contains cholesterol. Both bilirubin and cholesterol can crystallize – resulting in minute stones (gravel) a few millimeters in size or gallstones up to several centimeters in size. Physicians then speak of cholelithiasis.
Types of gallstones
- Cholesterol stones: These consist mainly of cholesterol and are responsible for about 80 percent of all gallstone cases in Germany.
- Bilirubin (pigment) stones: These consist of a cholesterol core to which bilirubin has attached. Bilirubin stones cause about 20 percent of gallstone diseases.
Another distinguishing criterion is the location of the gallstones. Here, a differentiation is made between:
- Bile duct stones (choledocholithiasis): They are located in the connecting duct between the gallbladder and the small intestine. Sometimes they form on site. Often, however, they are actually gallbladder stones that have been washed out into the bile duct (secondary bile duct stones).
Frequency of gallstones
Many sufferers do not even know that they have gallstones because they do not (yet) cause any symptoms.
Gallstones: causes and risk factors
Risk factors of the 6-f rule
Certain risk factors favor the development of gallstones. The most important ones can be summarized in the so-called 6-F rule:
- female
- fat (overweight)
- fertile (fertile, several children)
- forty (age 40 and over)
- fair (blond, light-haired)
- family (family disposition)
Very rarely, a genetic defect is present, which in any case leads to the formation of gallstones.
Other risk factors
Other risk factors for the development of gallstones include:
- Pregnancies
- Taking female sex hormones, such as contraceptives (the pill) or hormone replacement therapy during menopause
- certain other medications, such as ceftriaxone (an antibiotic) or somatostatin (for the hormone disorder acromegaly or for upper digestive tract bleeding)
- Bile acidosis syndrome (disease with relevant deficiency of bile acids, e.g. as a result of surgical removal of a large part of the small intestine – e.g. in Crohn’s disease)
- diabetes mellitus
- Cirrhosis of the liver (e.g. due to high alcohol consumption)
- elevated blood fat levels (triglycerides, cholesterol)
- severe overweight (obesity)
- special, high-calorie tube feed
The fact that women get gallstones more often than men is probably due to female sex hormones. This is also supported by the fact that taking such hormones (for example as contraceptive pills) and pregnancy also increase the risk of cholelithiasis.
Gallstones: symptoms
Sometimes “silent” stones become “talking” over time, that is, they begin to cause discomfort. According to studies, two to four out of every 100 people with gallstones develop noticeable symptoms within a year.
Sometimes gallstones also trigger biliary colic – severe, cramp-like pain in the right middle and upper abdomen. They are wave-like: the pain swells rapidly, then reaches a plateau and subsequently subsides spontaneously or after taking medication.
Biliary colic occurs mainly at night and often not in chronological order after a meal.
Approximately every second patient who has already experienced gallstone symptoms such as colic will experience symptoms again within two years.
Size and location of gallstones determine
The accumulation of bile as a result of an outflow obstruction is referred to by physicians as biliary stasis (cholestasis).
Gallstones: complications
Gallstones can have various effects:
Gallbladder inflammation and possible consequences
If left untreated, acute gallbladder inflammation can lead to pus formation in the gallbladder (gallbladder empyema) – possibly even with partial death and thus rupture of the gallbladder wall (gallbladder perforation). In extreme cases, the peritoneum may also become inflamed (“bilious” peritonitis).
Sometimes gallbladder inflammation is not acute, but chronic. In very rare cases, the gallbladder wall can thicken and calcify as a result – doctors refer to this as “porcelain gallbladder”. The organ can then no longer contract properly. A certain form of “porcelain gallbladder” also increases the risk of gallbladder cancer.
Bile duct inflammation and jaundice
Like gallbladder inflammation, bile duct inflammation can spread to neighboring organs.
Pancreatitis
Acute pancreatitis often subsides spontaneously. However, the same applies here: The inflammation can spread to neighboring organs.
Gallbladder and bile duct cancer
Gallstones increase the risk of gallbladder cancer and bile duct cancer – but only slightly. In addition, both types of cancer are rare: Overall, the number of new cases per year in Germany is only about 5,000.
Gallstones: examinations and diagnosis
If you are suspected of having gallstones, the doctor will first take your medical history in a detailed consultation. Among other things, he will ask you to describe all your symptoms in detail. He will also ask about any previous or underlying diseases. This is followed by a comprehensive physical examination and imaging procedures.
Imaging procedures
A special X-ray examination, endoscopic retrograde cholangiopancreatography (ERCP), can also detect gallstones in the gallbladder and bile duct. In addition, smaller stones can be removed immediately during the examination.
Blood test
Further examinations if required
Sometimes gallstones occur under unusual circumstances – for example, in families, in childhood or adolescence, or repeatedly in the bile duct. In this case, further examinations should clarify the exact cause. For example, if a specific genetic cause is suspected, a genetic analysis may help.
Gallstones: Treatment
Therapy of biliary colic
The physician treats acute biliary colic with antispasmodic and analgesic drugs (spasmolytics and analgesics) such as ibuprofen. If the gallbladder has become inflamed, the patient also receives antibiotics. In the first 24 hours after the onset of biliary colic, the patient is also not allowed to eat any food (zero diet).
Therapy of gallstones
Gallbladder stones usually only need to be treated if they cause discomfort or complications such as gallbladder inflammation. Bile duct stones, on the other hand, should always be treated because they often lead to complications.
Removing gallstones
There are several methods for removing gallstones. Which method is used depends, among other things, on the location (gallbladder or bile duct) and size of the gallstones.
An alternative to surgery in certain cases is the treatment of gallstones with medication. In this case, the patient must take a drug that can dissolve the stones over a longer period of time. In addition, gallstones can also be broken up with the help of shock waves (shock wave therapy).
Comprehensive information on the various removal methods can be found in the article Removing gallstones.
Gallstones: diet
In addition, you should eat a diet rich in whole grains and fiber. Include whole-grain products, vegetables and fruit in your diet on a regular basis. This diet – in combination with regular exercise and sport – can help you maintain a healthy body weight or reduce excess fat. Excess weight is one of the most important risk factors for gallstones.
Gallstones: course and prognosis
Gallstones that cause symptoms are generally quite easy to remove. Surgery has the best prognosis. This often involves removal of the gallbladder. Relapses (with gallstone formation in the bile duct) are relatively rare afterwards. With non-surgical treatment, the relapse rate is higher.
