What Causes Gallstones?

Several factors contribute to the development of gallstones. These include age, gender, genetics, and certain diseases and conditions.

The risk of developing cholesterol gallstones increases with age, and it’s thought that aging is related to reduced production of bile acid (Pak 2016). Other risk factors include abdominal obesity and diabetes mellitus. Those who have had a family member with gallstones also have an increased risk.

Prevalence

A western diet high in saturated fats and cholesterol and low in fiber is one of the strongest risk factors for developing gallstones. Obesity is also a risk factor, especially in women. Fasting and rapid weight loss, as well as prolonged fasting and weight cycling (eg, a “yo-yo” diet) can increase the risk of gallstone formation, but gradual weight loss and exercise can decrease the risk.

Other risk factors include age, gender, ethnicity, and a family history of gallstones. Hormone therapy can also significantly elevate the risk of developing cholesterol gallstones, including oral contraceptives and postmenopausal hormone therapy. Estrogen can negatively affect bile production and gallbladder function, resulting in higher levels of cholesterol and increased oxidative stress that can lead to the formation of gallstones (Simonsen 2013; Dhiman 2006).

Certain diseases and conditions, such as cirrhosis or nonalcoholic fatty liver disease, may also increase the risk of developing cholesterol gallstones. Celiac disease, which can impair gallbladder function, has also been linked to a higher risk of developing cholesterol gallstones. Other medical conditions that can raise the risk of gallstones include cystic fibrosis, nonalcoholic steatohepatitis, sickle cell anemia, and hemolytic anemia (Sekine 2015; Njeze 2013; Shaffer 2018).

Abdominal ultrasound is a reliable diagnostic tool for detecting gallstones as well as identifying bile duct blockage or obstruction. It is particularly sensitive for detecting stones that are small, sludge-like, and difficult to detect on an X-ray. A CT scan can identify a stone, but is less accurate in detecting bile duct blockage or obstruction.

Physical activity is a proven preventive measure against cholesterol gallstones. It can also lower the risk of silent gallstones and reduce complications such as cholecystitis, bile duct infection, and pancreatitis (Shabanzadeh, Sorensen, Jorgensen 2017b; Chuang 2001).

Dietary changes are the most effective treatment for gallstones. Eating a high-fiber, plant protein, and mono- and polyunsaturated fat-rich diet helps to lower cholesterol and triglyceride levels and can prevent the formation of cholesterol gallstones. It also increases vitamin C and dietary iron, two nutrients that can help to reduce the burden of oxidative stress and promote the formation of bile acids that dissolve gallstones.

Symptoms

Gallstones are hardened, calcified deposits of cholesterol and bile salts. They form in the gallbladder (bile duct). They often cause pain and discomfort. They can also block the flow of bile from the gallbladder into the small intestine. In severe cases, they can cause infections in the bile ducts or pancreas, and can be life-threatening.

They can float out of the gallbladder, or they can get caught in the bile ducts and stop them from draining properly. This may cause abdominal pain and tenderness, as well as nausea, vomiting, belching, and a change in appetite or weight loss.

Sometimes, stones that have gotten stuck in the common bile duct can cause a serious infection called acute cholecystitis. This inflammation can lead to a fever and jaundice (yellowing of the skin and eyes) that can be dangerous.

The most common gallstone treatment is surgery to remove the gallbladder (cholescystectomy). This can be done on an outpatient basis, or it may require an overnight stay in the hospital.

Other options include oral dissolution therapy, in which ursodeoxycholic acid (Actigall) and chenodiol (Chenix) are taken orally, usually in a liquid form. It can take months or years for these drugs to work completely, but they are effective about half the time.

For people with a lot of calcium in their stones, doctors might use shock wave lithotripsy, which uses waves to break up the stones. This is a procedure that is very painful but can be used to break up large stones.

These treatments are not usually effective for all gallstones, and they can be expensive. If they don’t work, other treatments may be tried to break up the stones.

Aside from medicines, there are also lifestyle changes that may lower your risk of gallstones. A healthy diet that includes plenty of fiber and good fats can reduce your risk. Avoid foods that are high in cholesterol, fatty acids, and refined carbohydrates.

Eating a lot of fruits and vegetables, especially dark green ones, can help prevent gallstones. This is especially true if you have diabetes or other health conditions that increase your risk of gallstones.

Diagnosis

Diagnosis is critical for making the right treatment decisions. There are a number of tests that can be used to detect gallstones and evaluate their severity. These include an abdominal ultrasound, X-rays, a cholescintigraphy scan (HIDA), and endoscopic retrograde cholangiopancreatography.

The first logical step is to take a detailed history of your symptoms and have your gallbladder inspected. This may be done by a gastroenterologist, a doctor of internal medicine, or an obstetrician. The doctor will also perform a physical exam and may want to order lab tests for a more comprehensive evaluation of your condition.

One of the best ways to determine if you have gallstones is to get an ultrasound. An ultrasound is highly accurate in detecting gallstones, and it can also find other medical conditions that affect the gallbladder or the bile ducts, such as an abscess or perforation.

Another useful diagnostic test is a cholescintigraphy or HIDA scan, which can be performed by injecting a radioactive tracer into the blood to visualize the state of the gallbladder. This test can be done in the office or in an operating room, and it is a great way to see if you have acute cholecystitis.

While this type of scan can also detect silent gallstones, it is less likely to identify symptomatic stones and to provide the information needed to make an informed treatment decision.

The most important thing to know about gallstones is that they are a common problem, and there are several ways to reduce your risk of developing them. These include eating a healthy diet, exercising regularly, and taking preventative measures to reduce cholesterol levels and other factors that increase your risk of gallstone formation.

Treatment

Gallstones don’t cause symptoms in most people, but they can be problematic if they block the bile duct. These blockages can lead to dangerous complications, such as jaundice and pancreatitis. They also can cause the gallbladder to calcify, which can increase the risk of cancer.

Symptoms can range from nonspecific indigestion to severe abdominal pain that may be referred elsewhere in your body. They can also be accompanied by nausea and vomiting.

Treatment options for ox gallstones Finland include medications, surgery and extracorporeal shock wave lithotripsy (ESWL). The medications act on the cholesterol in your bile to break up the gallstones. They work best for small, noncalcified stones that contain no calcium and are confined to the gallbladder. They usually relieve symptoms within two to three months but may take years to completely dissolve the stones.

Oral dissolution therapy involves taking a medication called ursodeoxycholic acid (Actigall) or chenodiol (Chenix). The medicines reduce the amount of cholesterol in your bile and promote the breakdown of cholesterol-rich stones. It may take up to months or years for the ursodeoxycholic acid to fully dissolve all gallstones, and you may need to take it again.

If your gallstones are large, your doctor may recommend a surgical procedure called cholecystectomy. The surgeon removes the gallbladder and part of your bowel to allow the bile to pass more easily. It’s a minor surgery that can improve your quality of life.

Some patients can be treated with a nonsurgical technique that uses an injection of a chemical called MTBE to dissolve the gallstones. This method is not usually recommended, but it’s an option for some patients who are unable to undergo surgery or for patients who can’t tolerate the side effects of surgery.

Other nonsurgical treatments include oral chemotherapy, which uses a medicine called neomycin to dissolve gallstones. The drug works by decreasing the amount of cholesterol in your bile, reducing inflammation in your bile and lowering the pressure on your gallbladder.

Nonsurgical procedures such as ERCP and EUS are used to diagnose gallstones. During these procedures, your doctor passes a thin tube (endoscope) through your mouth and through your digestive tract to look at your gallbladder and bile ducts. These tests can help identify small gallstones that can’t be seen by a regular ultrasound.

What Causes Gallstones?