Dealing with gallstones

Gallstone disease is one of the most common disorders affecting Indians today. About 10% of the population suffers from gallstones. However, since the initial symptoms of the disease are negligible, the treatment is usually delayed.

There are two types of gallstones namely, cholesterol and pigment. Cholesterol stones are yellowish green in colour and are predominantly found in women and obese individuals. They account for 80% of gallstones and are involved in obstruction and inflammation. Pigment stones, on the other hand, are black or brown stones that are made of pure calcium bilirubinate. These typically remain in the gallbladder due to pooling of bile or excess unconjugated bilirubin.

A sedentary lifestyle is one of the major causes for gallstones. Some of the other reasons are: increased usage of medications such as contraceptive pills and estrogen replacement drugs. Gallstones are more common among women than men.

Gallstone disease may not be symptomatic until there are complications. Often, these complications are caused by inflammation, infection or ductal obstruction. About 70% to 80% of symptomatic patients complain of severe pain due to spasm due to obstruction of the cystic duct by a stone. This pain is felt in the upper abdomen or right part of the upper abdomen. It is sudden and severe accompanied by vomiting and excessive sweating.

Some of the main complications caused by gallstones are gallbladder inflammation, bile duct stones, bile duct inflammation, inflamed pancreas and abnormal communication between the gall bladder and the small intestine.

Gallbladder cancer

Once the gallstones are removed, it is important to conduct a biopsy on them to rule out the chances of gallbladder cancer. About 70% of all gall bladder cancer cases are diagnosed in patients who have undergone removal of stones. Women above 65 years are at a greater risk of gall bladder cancer.

Liver function tests, complete blood count, and amylase and lipase enzyme tests are the usually conducted to identify gallstones.

Here are some treatment options:

Surgical therapy: Cholecystectomy is the only definitive treatment for symptomatic gallstones. While open cholecystectomy was the standard surgical option for patients in the past, laparoscopic cholecystectomy is now an option in most instances.

Medical therapy: Ursodeoxycholic acid and HMG CoA reductase inhibitors suppress de-novo hepatic cholesterol synthesis. This results in the secretion of under saturated bile, helping the stone to get dissolved.

Shock therapy: This is a nonsurgical alternative to manage gallstones in patients who are not fit for surgery. This method employs high-energy sound waves that produce shock waves. These are transmitted through water and tissue and can break the gallstones.

You can follow some simple steps to prevent gallstone disease:

Exercising regularly will help reduce cholesterol, which causes gallbladder problems. Any moderate activity for at least 30 minutes for five days a week is recommended.

It is important to eat a well-balanced diet that includes fruits, vegetables, whole grains, low-fat dairy products and lean meats. Avoid high-fat foods like whole-milk products, processed foods, sugary items, fried foods and red meats. Losing and gaining weight in cycles is linked to gallbladder problems. Hence, ensure that you don’t lose weight too quickly.

If you’re not getting enough fibre or Vitamin B in your diet, make sure you take alternative supplements. You can also take omega-3 supplements or add fish like salmon, tuna and trout to your diet. Omega-3 can help in preventing cholesterol from forming bile in the gallbladder.

(The author is chief of Gastrointestinal Surgery at Columbia Asia Hospital.)