It is estimated that the gallbladder of every tenth citizen of Germany fills with gallstones. Painful biliary colic can be caused by gallstones. If so, the gallbladder must be removed completely or, if there are stones in the bile ducts, the stone must be removed endoscopically from the bile duct, crushed or dissolved.
Stony gallbladder may hurt
The pear-shaped gallbladder is an appendage of the liver. It lies between the main trunk of the bile ducts that lead out of the liver and the bile duct that empties into the duodenum. The function of the gallbladder is to store the bile produced by the liver for fat digestion. When needed, the gallbladder wall contracts – controlled by nerves and hormones – and releases the bile into the duodenum.
Risk factors for gallstones include a high-calorie, high-carbohydrate diet with high cholesterol intake and obesity, as well as fasting cures and radical diets. This is because if no food is consumed, the gallbladder does not empty regularly and the bile slowly thickens. A low-fiber diet is also unfavorable because increased cholesterol is absorbed from the intestines.
When to remove the gallbladder?
Stones in the gallbladder, as well as those that have migrated into the bile ducts, can cause pain. Biliary colic occurs, for example, when a stone enters the bile ducts, causing the wall of the bile duct to contract like a spasm.
If there are stones in the gallbladder and biliary colic has occurred for more than 15 minutes, the gallbladder should be removed by minimally invasive gallbladder surgery (cholecystectomy). This is a minimally invasive laparoscopic removal of the gallbladder, which means it is performed without an abdominal incision. But don’t worry, a person can live without a gallbladder.
Even if possible gallstones themselves do not cause any problems, the procedure is necessary if polyps are present in the gallbladder. Namely, they can lead to gallbladder cancer.
Furthermore, the gallbladder is removed in the case of gallstones that are already larger than three centimeters or in the case of a so-called porcelain gallbladder with an increased risk of cancer. A porcelain gallbladder is present when the gallbladder wall has hardened as a result of chronic gallbladder inflammation. When the indication for surgery is correct, more than 85 percent of patients who undergo surgery benefit from the procedure.
Surgery not always necessary
If an ultrasound accidentally detects gallstone gravel or small gallstones that do not cause pain, gallbladder surgery is not necessary. Those who have gallbladder stones and complain of discomfort such as bloating, flatulence, and a feeling of pressure in the upper abdomen, but have not yet had biliary colic, can first try low-dose ursodeoxycholic acid after consulting with their doctor.
Ursodeoxycholic acid is a bile acid that, even in low doses, has an anti-inflammatory effect on the gallbladder wall, inhibits stone formation, promotes emptying of the bladder and promotes the flowability of bile. Complaints such as upper abdominal pain and flatulence then occur less frequently.
When gallstones migrate in the bile ducts
Small stones often migrate out of the bile ducts on their own when the area where the bile duct meets the duodenum is dilated with a small incision. If larger stones are in the bile ducts, they can be removed endoscopically using a type of catch basket.
Gallstones can also be broken up by external shock waves (extracorporeal shock wave lithotripsy, or ESWL). It is possible to “shatter” up to three stones at once. A prerequisite for ESWL is that the bile ducts are clear so that the fragments can be excreted via the intestines. Pure cholesterol stones in the gallbladder under five millimeters in size can also be dissolved with medication (litholysis). However, this process takes three months to two years and has a success rate of about 40 percent.
Gallstones often recur – especially after ESWL – after three to five years. However, those who change their diet to be “lower in fat and cholesterol” and reduce weight can prevent new formation. Drinking coffee also seems to have a positive effect.
