Gallbladder Disease and Gallstones – How Are They Related?
~ by Jo Jordan
According to the third National Health and Nutrition Examination Survey, in the United States 6.3 million men and 14.2 million women between the ages of twenty and seventy-four suffer from gallbladder disease, and one million new cases of gallstones occur every year.1
Understanding the relationship between the gallbladder, gallstones, and gallbladder disease is vital to nipping many potentially serious digestive problems in the bud.
What Is the Gallbladder?
The gallbladder – or cholecyst as it is sometimes called – is a small, pear-shaped organ located on the right side of the abdomen, on the underside of the liver. Its function is to store and concentrate the bile produced in the liver until it is secreted into the upper small intestine (sometimes referred to as the duodenum) to aid in fat digestion.
Gallbladder Disease (GBD) – What Causes It?
There are predominantly two types of GBD: cholecystitis, an inflammation of the gallbladder, and cholelithiasis or choledocholithiasis, more commonly known as gallstones.
Simply put, GBD (also known as biliary disease, biliary colic, gallbladder attack, and gallbladder dysfunction) is swelling of the gallbladder. Conditions that retard or interfere with the flow of bile from the gallbladder can result in GBD. Inflammation – most often a result of a gallstone blocking a passageway in the gallbladder – causes what is referred to as a gallbladder attack.
In addition to gallstones, GBD includes infection, inflammation, and/or other obstructions of the gallbladder.
But to understand the underlying cause of GBD, it is necessary to know what causes gallstones. Scientists suggest the cause is multifaceted, including factors such as diet, body weight, gallbladder movement, and genetics.
While no unchallenged evidence exists linking diet to gallstones, many researchers believe that diets high in starchy foods and cholesterol and low in fiber contribute to the formation of gallstones.
In addition, increased levels of estrogen – brought on by birth control pills, pregnancy, or hormone replacement therapy – may elevate the levels of cholesterol in bile and decrease gallbladder movement, providing a fertile environment for the development of gallstones.
Hereditary blood cell disorders, cirrhosis, and biliary tract infections are risk factors for the formation of pigment stones.
But What, Exactly, Are Gallstones?
Formed in the gallbladder or its ducts, gallstones are lumps of solid material known as cholesterol or pigment stones.
Gallstones vary considerably, from the size a grain of sand, to those as large as a crab apple. The gallbladder can develop several thousand small stones, or a single large one...and everything in between.
Initially, gallstones may briefly block the bile duct, and then move away, causing only occasional pain. Continuous blockage of the bile duct, however, can be life threatening, and would require removal of the gallbladder.
The Chicken or the Egg: Gallbladder Malfunction or Gallstones – Which Comes First?
While it is true that GBD can be caused by conditions that slow down or block bile flow from the gallbladder, it is also the case that when the gallbladder is malfunctioning, the components of the bile – namely bile salts, bilirubin, and cholesterol – become out of balance, leading to the formation of gallstones.
GBD Symptoms and Related Conditions
While ninety percent of gallstone cases are not accompanied with pain or any other symptoms,2 the most common reason for GBD is gallstones.3
Symptoms vary considerably from mild discomfort and debilitating pain, to severe cases accompanied by fever, nausea, and jaundice. Other symptoms include,
- Abdominal fullness or gas
- Chest pain beneath the breastbone
- Chills and shaking
There is some disagreement among researchers about whether or not digestive complaints such as belching, bloating, feeling unduly full after meals, heartburn (burning feeling behind the breast bone), or regurgitation (acid back-up in the food pipe) are caused by GBD. One report suggests that gastroesophageal reflux disease, indigestion, or peptic ulcers may be potential causes for these symptoms.4
Biliary colic (also referred to as biliary pain, classic gallbladder attack, or chronic cholecystitis) is the most common symptom of gallbladder disease. Attacks are often brought on through the consumption of fatty foods or fluids.
While symptoms are variable, the abdominal pain associated with GBD is often severe, located on the right side, or in the upper middle part of the abdomen. The pain can worsen during deep breathing, may radiate to the back or below the right shoulder blade, and is sometimes associated with vomiting. In simple cases, the pain usually lasts from thirty minutes to several hours, followed by a day or two of less intense soreness. GBD can cause chronic nausea.
Biliary pancreatitis is a condition that occurs when gallstones pass by the pancreatic duct, irritating the pancreas, and leading to this potentially serious condition. Symptoms usually consist of mid-abdominal pain radiating to the back with nausea and vomiting.5
Choledocholithiasis (also known as common bile duct stones) is a condition whereby gallstones drop out of the gallbladder and into the common bile duct. These stones often pass into the intestines without incident.
However, sometimes they can cause obstructions in the bile duct leading to jaundice and life threatening infections of the bile ducts.6
Other symptoms of choledocholithiasis include blood pressure drops, chills, dark urine, fever, light-colored stools, nausea, rapid heartbeat, severe pain in the upper right abdomen, and/or vomiting. These symptoms suggest cholangitis, an inflammation of the bile duct.
GBD Risk Factors
A common condition, GBD affects more women – especially those of childbearing age who’ve had children – than men. It is common in patients over forty years of age, or where obesity is a factor. Rapid weight loss and estrogen intake can increase the risk, as does diabetes and the ingestion of lipid (fat) lowering agents (LLA). GBD is also more prevalent in Native Americans and Mexican-Americans.
Various tests are available to determine the presence of gallstones or gallbladder inflammation:
- Abdominal CT (computerized tomography) scans take computer constructed X-ray images, detailed slices of the abdominal organs.
- Abdominal ultrasound uses sound waves to image the abdominal organs – it is the most accurate way to detect gallstones, and is quick and painless.
- An abdominal exam determines if the area is tender to the touch.
- Blood amylase levels are checked for pancreatic inflammation.
- Blood samples determine whether or not the liver is working normally – a CBC (complete blood count) will highlight any infection by an elevated white blood cell count.
- ERCP (endoscopic retrograde cholangio-pancreatography) is the most accurate way of assessing the common bile duct, and is used if bile duct gallstones are suspected. Under sedation, a small tube is inserted down the throat into the duodenum. A dye is injected into the duct, and an X-ray is taken. If gallstones are detected, they may be removed during the exam, making a subsequent operation unnecessary.
- HIDA (hepatobiliary iminodiacetic acid) scans use low level radioactive tracers to evaluate the function of the gallbladder and the bile ducts.
- Laboratory tests are used to check for jaundice and signs of liver inflammation.
- MRCP (magnetic resonance cholangiopancreatography), a relatively new type of MRI (magnetic resonance imaging), can obtain images of the internal organs without X-rays – effective for examining the common bile ducts for possible obstructions.
- Oral cholecystogram is a series of X-rays taken over two days to determine whether or not the gallbladder is capable of contraction – a diseased gallbladder may not contract or function properly.
GBD Treatment Options
In many situations, especially where pain is a constant issue, the gallbladder is removed via laparoscopic surgery. A minimally invasive procedure, this type of surgery results in a smaller incision, less pain, and a shorter hospital stay than open cholecystectomy, which is major abdominal surgery accompanied by several weeks of recovery time.
Some experts say that surgery does not always end the pain and discomfort, and a significant number of surgery patients develop post cholecystectomy syndrome, which involves gastrointestinal distress and persistent pain in the upper right abdomen.
Further, life without a gallbladder requires many adjustments, one of which is the fact that without one, the liver cannot always secrete enough bile for adequate digestion.
Drugs and Other Therapies
In some cases, non-surgical treatments such as lithotripsy – the use of high-energy shock waves to disintegrate gallstones – are an option. However, in fifty percent of these treatments, gallstones re-develop.
Drugs such as oral bile acid (ursodeoxycholic acid/UDCA/ursodiol) and methyl tert-butyl ether can be administered to dissolve stones, as well as solvents such as monooctanoin (Moctanin). However, treatment can take several years to dissolve the stones, and the recurrence rate is high.
Complementary Therapies for Treating GBD
Some studies indicate that acupuncture is extremely effective in treating the pain – as well as the obstructions – associated with gallbladder disorders.7 Treatment may also help to ease bile flow, reduce spasms, and promote gallbladder health and functioning.
Where gallstones are small enough, various homeopathic remedies can be effective in flushing out stones.8 In addition, chelidonium – a choleretic herb that promotes the production of bile – is recommended for specific types of gallbladder and abdominal pain.9
Nutritional supplements are often used to treat GBD. Milk thistle, for example, has been used for over 2,000 years to treat liver and gallbladder disorders.10
Lecithin (a key component of bile) is important for the breakdown of fat and cholesterol. Lecithin is believed to stimulate gallbladder function, and some animal studies suggest that lecithin-rich soy and buckwheat protein may provide protection against gallstones.11
While peppermint leaf is used for stomach/intestinal disorders and for GBD discomfort, peppermint oil ought to be used with caution by people with GBD.12
A large study conducted by the University of California, San Franciso, found that vitamin C deficiency may cause gallbladder disease in women,13 and daily supplementation of vitamin C is recommended as a remedy and preventive by other researchers.
A simple, old-fashioned remedy to help reduce the swelling associated with GBD is to apply a castor oil pack for three consecutive days to the abdomen:
Fold a clean, soft cloth into several layers. Saturate it with castor oil, place it in a baking dish, and heat it slowly in the oven. Rub some oil into the skin on your abdomen. Lay the warm cloth over your abdomen, cover with plastic wrap, and then cover with a heating pad or hot water bottle for one hour.14
Prevention, Treatment, and Long-term Gallbladder Health
The gradual implementation of an assortment of lifestyle changes is the best way to protect the health of your gallbladder, as well as ensure that your entire digestive system is operating at peak capacity.
- Activated charcoal helps to contain bile acid
- Avoid refined carbohydrates, including sugar and white flour
- Avoid saturated and trans fats
- Do not overeat
- Drink caffeinated coffee – some studies suggest it may lower the risk of developing gallstones
- Drink half your body weight in ounces of filtered water each day – about six cups
- Eliminate food allergens – high in cholesterol, eggs may irritate the gallbladder
- Exercise every day
- Implement a diet high in fiber, including lots of vegetables
- Implement a diet low in fat
- Liver flush every three or four months
- Parasite cleanse twice a year
- Reduce meat and dairy – eat lean meat only, and free-range, organic, and hormone-free products
- Reduce the load on your liver by eliminating processed foods, toxic personal care products (including those with phthalates such as coal tar hair dye, alpha hydroxy acids, and fragrance)
- Slowly shed excess weight
- Take digestive enzymes fifteen minutes prior to each meal
- Take probiotics
- Use omega 3 oils and other polyunsaturated fats
- Use supplemental bile salts and bile thinning agents
Liver Cleanse to Protect Your Gallbladder
With half-a-million chemicals in the environment today, and over five thousand new ones introduced each year, the body constantly battles to rid itself of toxins. They can become trapped in deposits of hardened bile, and may not get flushed out of the body.
Some physicians recommend a periodic flush of developing gallstones through liver cleansings, which can also help to purge various toxins from your liver before their presence develops into chronic problems.
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http://www.emedicine.com/med/byname/biliary-disease.htm (accessed July 29, 2008).
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http://www.umm.edu/altmed/articles/gallbladder-disease-000066.htm (accessed August 11, 2008).
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