Many of my patients with gallstones do not have symptoms and often do not even know they have them until the stones block the ducts of the biliary tract (a gallbladder attack), causing extreme pain that needs immediate medical attention. Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night.
Who gets gallstones?
Did you know that gallstones aren’t really stones? They’re actually hard particles that form in the gallbladder, the small, pear-shaped organ located in your upper right abdomen (the area between the chest and hips, below the liver). They can range in size from a grain of sand to a golf ball, and you can have a single large stone, hundreds of tiny stones, or both small and large stones.
The typical gallstone sufferers I see in my practice tend to match the national norms: women, over age 40 and slightly overweight. American Indians, Mexican Americans and people with a family history of gallstones also have a higher incidence of developing gallstones.
Symptoms of gallstones
As I said earlier, you might not even know you have gallstones unless your doctor tells you. (Lucky you! For many people, they are a constant source of pain and discomfort.) If you do experience symptoms, they usually include:
- Pain in your upper belly and upper back that can last for several hours
You may be at risk of developing gallstones if:
You’re more likely to develop gallstones if you meet one of the following criteria:
1) You’re obese. This is the biggest risk factor. People who are obese, especially women, have increased risk of developing gallstones. Obesity increases the amount of cholesterol in bile and makes it harder for the gallbladder to empty completely, both of which can cause gallstone formation.
2) You take birth control pills, hormone replacement therapy for menopause symptoms, or are pregnant. Elevated estrogen levels can increase cholesterol levels in bile and decrease gallbladder contractions, which may cause gallstones to form.
3) You have diabetes. People with this condition tend to have higher levels of triglycerides (a type of blood fat), which is a risk factor for gallstones.
4) You take medication to lower your cholesterol. Some cholesterol drugs boost the amount of cholesterol in bile, which may increase your chances of getting cholesterol stones.
5) Sudden weight loss. As the body breaks down fat during prolonged fasting and rapid weight loss, the liver secretes extra cholesterol into bile. Rapid weight loss can also prevent the gallbladder from emptying properly. Low-calorie diets and bariatric surgery typically lead to rapid weight loss and increased risk of gallstones.
6) Fasting. This may decrease gallbladder contractions, which may cause gallstones to form.
7) Gallstones run in your family. People with a family history of gallstones have a higher risk.
8) You’re female. Women are more likely to develop gallstones than men because of their higher levels of estrogen. Increased estrogen levels can also come from pregnancy, hormone replacement therapy or birth control pills.
9) You’re over 40. People over age 40 are more likely to develop gallstones than younger people.
10) You belong to certain ethnic groups, especially Native American or Mexican American. Because Native Americans have genetic factors that increase the amount of cholesterol in their bile, they have the highest rate of gallstones in the United States—almost 65% of Native American women and 30% of Native American men have gallstones. Also, Mexican Americans are at higher risk of developing gallstones.
11) You eat a diet high in calories and refined carbohydrates and low in fiber. Refined carbohydrates are grains that have been processed to remove bran and germ, important elements that contain nutrients and fiber (examples: white bread and white rice).
12) You have certain intestinal diseases. Diseases that affect the normal absorption of nutrients, such as Crohn’s disease, are associated with gallstones.
13) You have metabolic syndrome, diabetes and insulin resistance. These conditions increase the risk of gallstones. Metabolic syndrome is a group of traits and medical conditions linked to being overweight or obese that puts people at risk for heart disease and type 2 diabetes.
Treatment for gallstones
The usual treatment for gallstones is surgery to remove the gallbladder. Alternatively, nonsurgical treatments may be used to dissolve cholesterol gallstones. Surgery to remove the gallbladder, called cholecystectomy, is one of the most common operations performed on adults in the United States. The gallbladder is not an essential organ, which means a person can live normally without it.
There are two types of cholecystectomy:
1) Laparoscopic cholecystectomy. In this procedure, a surgeon makes several tiny incisions in the abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of organs and tissues. While watching the monitor, the surgeon carefully separates the gallbladder from the liver, bile ducts and other tissues, then removes it through one of the small incisions.
2) Open cholecystectomy. An open cholecystectomy is performed when the gallbladder is severely inflamed, infected or scarred from other operations. During this procedure, a surgeon makes a 4-6 inch incision in the abdomen to remove the gallbladder.
Two types of nonsurgical treatments can be used to dissolve cholesterol gallstones:
1) Oral dissolution therapy. Ursodiol (Actigall) and chenodiol (Chenix) are medications that contain bile acids that dissolve gallstones. Months or years of treatment with these medications may be needed to dissolve all stones.
2) Shock wave lithotripsy. Used only rarely, this treatment uses a machine called a lithotripter to crush the gallstones. The lithotripter generates shock waves that pass through the person’s body to break the gallstone into smaller pieces.
If you think you may have gallstones, please contact us
If you think you may have gallstones, please call (914) 232-1919 to make an appointment with one of our highly qualified Westchester Health physicians. We’ll perform tests and if you do in fact have gallstones, we’ll discuss your treatment options and together with you, decide on the best plan for your individual condition. Whenever, wherever you need us, we’re here for you.