Gallstones

GallstonesGallstones form in the gallbladder or bile ducts which transport the bile from the liver to the intestine. 10 to 20% of people have gallstones. The main reason for gallstone development is the imbalance between the individual bile components. The most common type are cholesterol gallstones which are formed because of an increased content of undissolved cholesterol in the bile.

Why should you have your DNA analysed for predisposition to gallstones?

We check the ABCGB gene in your genome. It is the gene that is involved in cholesterol metabolism, stimulating its excretion to the bile. We can discover your susceptibility to the imbalance in the bile contents even before large gallstones form.

How are gallstones prevented or treated?

Gallstones often do not cause symptoms, but colicky stomach pain may appear. If a stone blocks a bile duct, the bile accumulates and causes colicky pain, jaundice and inflammation of the bile ducts. The pancreas may also become inflamed. Smooth muscle relaxants are used to alleviate the colicky pain. The ultimate cure is the surgical stone removal.

More detailed description about gallstone disease

Gallstones are solid crystals of various salts that accumulate in the gallbladder or the ducts which transport the bile from the liver or into the intestines. Often, they cause no symptoms at all; they can, however, trigger a very severe attack.

Gallstones represent a huge medical problem in the developed world. The number of patients with gallstones keeps increasing. In the general population, the number of patients runs between 10 to 20% with a predominance in the Western countries. Fewer cases are recorded in Africa and Asia. The disease can affect any age group, but the incidence tends to increase with age. Mainly due to the influence of female sex hormones and pregnancy, women tend to be twice as affected as men.

Why do gallstones develop

The main cause of gallstones is an imbalance between individual substances present in the bile. There are two types of gallstones. By far the most common (up to 80%) are the cholesterol stones which appear due to an increased content of undissolved cholesterol in the bile. Such a mechanism of gallstone formation is the most prevalent one, especially in obese people. The other type are the so called pigment stones. They are characteristically black due to excess bilirubin in the bile (bilirubin is a special substance that forms as a by-product of haemoglobin (a protein that transports oxygen in the body) degradation).

There are multiple risk factors for the appearance of gallstones, the most important ones being the female sex (due to the effect of the sex hormones and pregnancy), increased body weight and obesity; fast weight loss by dieting as well as the age also augment the risk.

Problems related to gallstones

Most people with gallstones have no clinical symptoms. Gallstone patients usually have chronic complaints, but acute complications may appear as well. The most common symptom of gallstones is a sharp pain in the upper abdomen which may be accompanied by nausea and vomiting. At times, signs of indigestion (bloating, gasses) may appear which, however, are very unspecific.

The most common complication caused by gallstones is an obstruction of the common bile duct, liver and pancreatic duct, leading to the small intestine. The most common sign of this disease state is also abdominal pain, accompanied by jaundice (i.e. yellow skin discolouration) and vomiting. In the case of inflammation, fever may be present as well. The other possible complications include inflammation of the pancreas and increased predisposition to cancer development.

Due to the fact that a great number of patients with gallstones lack symptoms, gallstones are discovered in the context of examinations performed for other medical complaints. In the case of acute complications, however, the physician will soon suspect gallstones. In order to confirm the diagnosis, laboratory examination of the blood will be ordered (which may or may not reveal increased values of liver enzymes) as well as an abdominal ultrasound as a golden standard. In cases of complications, endoscopic ultrasound, computer tomography (CT) or magnetic resonance imaging (MRI) may be employed.

Prevention

The development of gallstones cannot be entirely prevented. If they appear, a diet may be employed to prevent their development, exacerbation of the condition and the reappearance of symptoms. Symptom-free individuals with gallstones should enjoy a low-fat diet and avoid the fried and poorly digestible food.

During a biliary colic attack, one should follow a fat-free diet, including eggs which are full of cholesterol and therefore stimulate gallbladder contraction. Following gallbladder surgery, a strict diet is no longer required, but patients tend to tolerate fatty foods less well.

Therapy

In the absence of symptoms, gallstones are generally not treated. In the case of frequent symptoms, however, there are the pharmacotherapy, surgery and the non-surgical treatment options available. The choice of the method depends on the size of the stones, their location and the type of symptoms they cause. The colicky pain may be alleviated with spasmolytic drugs and analgesics. Antibiotic treatment is required in the case of gallbladder inflammation.

The mainstream therapy of frequent biliary colic with pain on the lower right side of the abdomen is a surgical stone removal performed by a standard incision on that part of the body. A state-of-the-art method of stone removal that is increasingly performed is the laparoscopic cholecystectomy, characterized by small incisions in the abdomen to allow for the insertion of an optic tube and surgical instruments, and the removal of the stone-containing gallbladder. This procedure requires a shorter hospitalization and boasts a faster postoperative recovery.

When stones appear in the biliary duct, they may cause obstructive jaundice which is an emergency situation requiring either the surgical or the non-surgical stone removal. The non-surgical techniques employed to remove the stones from the biliary duct are the so called endoscopic papillotomy (EPT) and the endoscopic retrograde cholangiopancreatography (ERCP). In ERCP, an endoscope is inserted through the mouth and guided down to the opening of the common bile duct where a radiocontrast is injected into the bile duct. This allows for the visualization of the stone in the duct that can be subsequently endoscopically removed.

There are other non-surgical techniques available. Cholesterol stones may be dissolved by way of peroral and contact litholysis.

In peroral litholysis, acids such as the ursodeoxycholic acid (Ursosan) are employed. The effect of the lysis depends on the size and number of stones.

In contact litholysis the solvent methyl tert-butyl ether (MTBE) is applied into the gallbladder through a catheter. This method allows for the lysis of stones irrespective of their size and number.

The non-surgical treatment technique lithotripsy is used in selected patients. Stones are crushed with the use of extracorporeal shock waves; prior to the procedure, patients additionally get ursodeoxycholic acid which is also employed after the procedure.

A mixture of triterpene oils can be used as an addition in the therapy and prevention of gallstones.