Experts estimate that 20 to 25 million adults in the United States have gallstones -- hard, crystal-like clumps of debris that form in the gallbladder. About one third of people with gallstones experience an acute attack of abdominal pain. The good news is that gallstone disease can be cured.
What are gallstones? About 80% of gallstones are composed primarily of hardened cholesterol, sometimes mixed with calcium and bilirubin (a breakdown product of hemoglobin that is removed from the blood by the liver and secreted into the bile). The remainder, known as pigment stones, are composed primarily of bilirubin.
A gallstone can be as small as a grain of sand or as large as a golf ball. People may develop only a single large gallstone or hundreds, even thousands, of smaller ones. A gallstone attack is usually marked by steady, severe pain in the upper right abdomen that may last from 30 minutes to several hours. Other symptoms include nausea and vomiting, pain under the right shoulder, and pain between the shoulder blades. Indigestion after eating high-fat foods also is common. Although these symptoms may occur daily, a period of months or even years may elapse between episodes.
A stone that blocks the cystic duct (the tube that carries bile from the gallbladder to the common bile duct) may cause inflammation of the gallbladder (cholecystitis), whereas a stone that blocks the pancreatic duct may cause inflammation of the pancreas (pancreatitis). Warning signs of these serious problems include fever, jaundice, and persistent pain.
Who's at risk? Women are more likely than men to develop gallstones. The female hormone estrogen causes more cholesterol to be excreted in bile, which explains why hormone replacement therapy increases the risk of gallstones. Other predisposing factors include:
- Obesity, diabetes, and cardiovascular disease. People who are moderately overweight or obese tend to have increased levels of cholesterol and reduced amounts of bile salts in their bile, which may cause gallstones to form. Obesity also appears to decrease gallbladder emptying. Obesity is tied to diabetes and cardiovascular disease, and gallstones may be linked to these conditions as well.
- Rapid weight loss or fasting. Both events increase the risk of forming gallstones and cause silent gallstones to become symptomatic. Prolonged fasting may decrease gallbladder contractions. About one third of patients who undergo bariatric surgery to lose weight develop gallstones.
- Ethnicity. Native Americans have the highest rate of gallstones, and Mexican-American men and women also are at increased risk.
- Genetics. People with a family history of gallstones are more likely to have the disorder.
What you can do. Exercise and achieving and maintaining a healthy weight may help prevent gallstones from developing and limit attacks. Eating plenty of fiber, fruits, and vegetables and limiting your intake of refined sugar also appear to be protective.
If you have a gallstone attack, acetaminophen and over-the-counter nonsteroidal anti-inflammatory drugs can relieve pain. But gallstones that cause continued pain or block key ducts require surgery to remove the gallbladder (cholecystectomy). After surgery, stones can no longer develop, and bile empties directly into the intestine.
The majority of these operations are performed using a minimally invasive procedure called laparoscopic cholecystectomy, during which the gallbladder is removed through several tiny incisions made in the abdomen. The risk of infection is low because the incisions are minor, and recovery is less painful than with traditional open surgery because the procedure does not cut through stomach muscles. Patients usually stay overnight in the hospital and then spend several days recovering at home.
