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The gallbladder isn’t something people normally think about. Until, that is, a gallstone develops. Gallbladder attacks triggered by gallstones can be painful, but the standard treatment for gallstones can permanently put them in the past.
What are gallstones?
The gallbladder isn’t something people normally think about. Until, that is, a gallstone develops. Gallbladder attacks triggered by gallstones can be painful, but the standard treatment for gallstones can permanently put them in the past.
What are gallstones?
Gallstones are hardened lumps of cholesterol or other substances that form in the gallbladder. The gallbladder is a small, pouch-shaped organ in the upper right side of the abdomen that stores and releases bile acids that help the intestines absorb fats.
Also called cholelithiasis, gallstones are produced when concentrations of cholesterol or bilirubin, a waste product formed from the breakdown of red blood cells in the liver, become oversaturated in the gallbladder. When these substances accumulate in the gallbladder, they can mix with gallbladder mucus to form sludge. Crystals may form in this sludge and, over time, grow into hard, stone-like masses. Most gallstones are very small, but some can grow large enough to cause problems.
Besides an excess of cholesterol or bilirubin in the gallbladder, gallstones can also form when the gallbladder doesn’t sufficiently or regularly empty. Whenever we eat, the brain signals the gallbladder to empty its contents, otherwise known as bile, to help digest fats. Smooth muscles in the gallbladder contract, pushing the bile into the cystic duct and out through the bile duct to the duodenum, the upper part of the small intestine. If the gallbladder does not empty properly or regularly, then cholesterol may build up and start forming crystals. More than 85% of people with gallstones have cholesterol stones.
No matter what the cause, 80% of people with gallstones have no symptoms whatsoever. There is a risk that symptoms will develop as the years go by, but only one in five people with asymptomatic gallstones develop symptoms within 20 years.
Gallstones can cause problems when they get pushed into the cystic duct and cause an obstruction. When the gall bladder muscles contract after a meal, a stone can be pushed against the opening of the cystic duct, causing pain until the stone resettles.
A gallstone can also get pushed into the common bile duct and, if it’s big enough, cause sharp, continuous pain. If a stone gets lodged in the bile ducts, it can give rise to serious complications such as:
- Acute cholecystitis inflammation and swelling of the gallbladder.
- Choledocholithiasis a stone in the common bile duct blocks both the liver and gallbladder, so bile backs up into the liver.
- Pancreatitis stones can block the pancreatic duct, a tube that starts from the pancreas and meets the common bile duct before connecting to the duodenum. This blockage can cause pain and inflammation in the pancreas.
- Cholangitis impacted gallstones can lead to inflammation of the bile ducts, which is usually caused by a bacterial infection.
About 20 million people in the United States have gallstones, and twice as many men as women are affected. Because gallstones can form from excess cholesterol, excess bilirubin, or problems with emptying the gallbladder, there are a number of risk factors for gallstones including:
- High-cholesterol diets
- Low-fiber diets
- Rapid weight loss
- Fasting
- Excess body weight
- Diabetes and metabolic syndrome
- Liver disease
- Pregnancy
- Crohn’s disease
- Family history of gallstones
- Medications such as birth control pills, estrogen therapy, fibrates, and certain cancer drugs (somatostatins).
Bilirubin gallstones are caused by the excessive breakdown of red blood cells by the liver, so risk factors can include liver cirrhosis, cystic fibrosis, and hereditary red blood cell disorders such as sickle-cell anemia
How are gallstones diagnosed?
Gallstones are primarily diagnosed from symptoms, a physical exam, blood tests, and imaging tests, such as an ultrasound. Asymptomatic gallstones are typically discovered by accident on an MRI or ultrasound performed for some other reason. Most cases, however, are discovered once symptoms of gallstones begin.
Patients with gallstones typically have biliary colic symptoms such as:
- Episodes of sharp, constant pain in the upper right area of the abdomen
- Episodes of sharp, constant pain below the breastbone
- Pain in the back or right shoulder
- Nausea
- Vomiting
Complications of gallstones may involve symptoms such as:
- Constant pain in the upper right area of the abdomen
- Fever
- Tenderness in the gallbladder area
- Jaundice (yellowing of the skin)
- Dark urine
- Fast heartbeat
Once gallstones are suspected, a primary physician or gastroenterologist will perform an ultrasound which, in most cases, provides enough information to finalize a diagnosis. Ambiguous cases or impacted stones may require different imaging tests including:
- Hepatobiliary iminodiacetic acid (HIDA) scan. Also known as cholescintigraphy, a HIDA scan is the most accurate method to detect blockages. The scan follows a radioactive substance as it passes through the liver into the gallbladder and out to the intestine. The whole process usually takes about one to two hours.
- CT scan. A CT scan can show gallstones, or they may be used to detect complications of gallstones, such as acute cholecystitis or swelling of the pancreas.
- Magnetic resonance cholangiopancreatography (MRCP). An MRCP is an MRI of the liver, gallbladder, bile ducts, and pancreas. It may be used when the doctor suspects complications such as cholecystitis, pancreatitis, liver damage, or infection. The scan typically takes about 40 minutes—about twice as long as a routine MRI.
- Endoscopic retrograde cholangiopancreatography (ERCP). An ERCP is an X-ray of the bile and pancreatic ducts after a contrast dye has been introduced into the bile using an endoscope. The patient is sedated during the procedure, which normally takes 30 to 90 minutes. One advantage of the procedure is that the physician can use the endoscope and electrically generated heat (electrocautery) to widen narrow ducts. They can then remove any stones causing bile duct blockage.
Gallstones treatment options
Treatment of gallstones depends on the symptoms. Most people with gallstones do not experience symptoms, so treatment consists of lifestyle and dietary changes to reduce the risk of symptoms.
When symptoms do appear, treatment normally involves the surgical removal of the gallbladder, a procedure called a cholecystectomy. However, some patients experiencing their first bout of gallstone symptoms may be sent home with pain relievers.
Treatment for gallstone complications usually involves the surgical removal of the gallbladder and, possibly, other interventions such as antibiotics or other surgical procedures. The surgery will require a hospital stay, but patients with infections will likely require intensive care.
Surgery
The gold standard for treating symptomatic gallstone treatments is the surgical removal of the gallbladder, called laparoscopic cholecystectomy. The removal of the gallbladder essentially fixes the problem for good. Typically performed by a general surgeon, four small incisions are made in the abdomen through which instruments and a laparoscope are inserted. At the end of the laparoscope is a camera that feeds an image to a video monitor to guide the surgeon in removing the gallbladder and the cystic duct. The surgeon may also need to remove impacted stones using ERCP.
A cholecystectomy may alter digestion, so common side effects may include difficulty digesting fats, diarrhea, constipation, and flatulence. Because the abdomen is inflated with gas to perform the surgery, patients often experience shoulder pain for a few days after the surgery.
Medications
Some medications dissolve gallstones, but they only work for a narrow range of cases. They are not very effective in the long-term, so they are prescribed only for people unable to undergo surgery.
Extracorporeal shockwave lithotripsy (ESWL)
ESWL, commonly used to break up kidney stones, is an alternative for people unable to undergo surgery. High-energy sound waves are directed at the gallstones to break them up, allowing them to pass through the bile ducts. It can be an effective treatment for small gallstones. However, because it might not fix the underlying problem, there’s a possibility that gallstones can return.
Gallstones medications
The standard treatment for symptomatic gallstones is gallbladder removal. Pain medications and other drugs may be used to ease pain during a gallbladder attack. Medications that shrink gallstones may be used in special but rare cases.
NSAIDs
Nonsteroidal anti-inflammatory drugs are the first-line therapy to manage the pain of acute biliary colic or complications of gallstones. Prescription NSAIDs such as diclofenac, ketorolac, flurbiprofen, celecoxib, and tenoxicam are commonly administered either orally or intravenously. NSAIDs can help relieve pain, inflammation, and fever from gallstones or complications caused by gallstones.
Opioids
In patients who do not respond to or cannot take NSAIDs, an opioid such as morphine or meperidine may be used to control the pain of biliary colic or more severe complications.
Anticholinergics (spasmolytic drugs)
The pain of biliary colic is often triggered by muscle contractions in the bile duct to try and move the stone. Spasmolytic drugs such as hyoscyamine and scopolamine relax the gallbladder by blocking a chemical— acetylcholine—that nerves use to signal muscles to contract. Spasmolytic drugs may be prescribed instead of NSAIDs to manage gallbladder attacks.
Gallstone dissolution agents
Patients who are unable to undergo surgery may be prescribed medications that promote the dissolving of gallstones. Ursodeoxycholic acid (ursodiol) and chenodeoxycholic acid (chenodiol) work by decreasing the amount of cholesterol secreted by the liver. As cholesterol levels in the gallbladder go down, cholesterol crystals and gallstones slowly dissolve. The treatment takes six to 12 months, but only one out of ten patients have gallstones that are treatable by dissolution agents.
What is the best medication for gallstones?
Most gallstones do not cause symptoms, so the primary treatment is to watch and wait. The standard treatment for symptomatic gallstones is the surgical removal of the gallbladder. Medications may be used for pain control and, in patients unable to undergo surgery, to dissolve gallstones. There is, then, no “best” medication for gallstones, only the most appropriate treatment for the symptoms and situations of individual patients.
| Best medications for gallstones | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Dyloject (diclofenac) | Nonsteroidal anti-inflammatory drug (NSAID) | Injection or oral | 37.5 mg injected intravenously every six hours not to exceed 150 mg per day | Nausea, constipation, headache |
| Toradol (ketorolac) | Nonsteroidal anti-inflammatory drug (NSAID) | Injection or oral | 30 mg injected intravenously every six hours not to exceed 120 mg per day | Abdominal pain, headache, drowsiness |
| Celebrex (celecoxib) | Nonsteroidal anti-inflammatory drug (NSAID) | Oral | 200 mg twice daily as needed | Diarrhea, nausea, headache |
| Kadian (morphine) | Opioid | Injection or oral | Dosage is individualized based on pain levels and past medical history | Drowsiness, lightheadedness, nausea |
| Levsin (hyoscyamine) | Anticholinergic | Oral or injection | 0.125 to 0.25 mg every four hours or as needed, not to exceed 1.5 mg per day | Dry mouth, urinary retention, dizziness |
| Actigall (ursodiol) | Gallstone dissolution agent | Oral | Dose depends on weight; capsules are taken in two to three divided doses throughout the day | Diarrhea, stomach upset, backache |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of gallstones medication?
The side effects of gallstones medications will vary depending on the type of medication. This is not a complete list of possible side effects, so please consult with your healthcare provider if you have any questions or concerns about possible side effects or drug interactions.
NSAIDs (nonsteroidal anti-inflammatory drugs) are safe, but prescription NSAIDs are more likely to produce side effects than over-the-counter versions, such as aspirin or ibuprofen. NSAIDs may interfere with both blood clotting and the body’s ability to protect the digestive system from stomach acid. The most common side effects of NSAIDs, then, are digestive system and bleeding problems, such as stomach pain, abdominal pain, ulcers, bleeding, and bruising. Patients with bleeding problems may be prescribed celecoxib, an NSAID that has a lower risk of gastrointestinal bleeding.
Opioids relieve pain by slowing down or blocking pain signals in the central nervous system. Most people, then, may experience side effects like sleepiness, fatigue, dizziness, and general fogginess. Opioids can also block signals smooth muscle contractions in the gallbladder, which could interfere with gallbladder emptying.
Anticholinergic drugs block nerve signals to involuntary smooth muscles such as those found in the gallbladder, causing those muscles to relax. These drugs may cause side effects such as dry mouth, blurred vision, constipation, and sedation. Anticholinergics can also affect heart rate and blood pressure, so some patients may not be able to take them.
Some people taking gallstone dissolution agents may experience side effects. Digestive system problems such as abdominal pain, diarrhea, stomach upset, and nausea are the most common. Headaches and viral infections are also common.
What is the best home remedy for gallstones?
Once symptoms appear, gallstones can lead to potentially hazardous complications. Home remedies will not help symptomatic gallstones, so patients should immediately seek out medical advice when the pain begins. Fortunately, most gallstones produce no symptoms, so medical treatment is to wait and see. However, there are effective lifestyle changes that can prevent asymptomatic gallstones from becoming a problem.
Eat meals at a regular time
Put yourself on a regular meal schedule. Eating stimulates the gallbladder to contract, and gallstones form when the gallbladder sits and does nothing. A regular, three-meal-a-day schedule keeps the gallbladder active enough to stop gallstones from forming or growing bigger.
Lose weight gradually
Excess weight is a prime risk factor for gallstones, so it’s a good idea to shed a few pounds. Unfortunately, fast weight loss is another prime risk factor for gallstones. Significantly reducing your food intake keeps the gallbladder inactive for longer periods of time. When losing weight, you should decrease overall calories but only moderately decrease your food intake. Stick to a three-meal-a-day regimen and make sure you increase your physical activity.
Avoid fasting
Fasting has recently blossomed into a trendy health regimen, but it puts the gallbladder on hold for long periods—a perfect recipe for growing gallstones. If you have asymptomatic gallstones, the best treatment is to continue to eat healthy foods on a regular schedule.
Reduce cholesterol intake
Most gallstones form from cholesterol crystals in the gallbladder. Reducing cholesterol intake reduces the raw material gallstones need to keep growing.
Eat low-fat meals
The gallbladder is stimulated by fats in the diet. The more strongly it contracts, the more likely a gallstone may block some of the plumbing. Low-fat diets keep the gallbladder busy emptying its contents, but without the big push provoked by high-fat diets.
Frequently asked questions about gallstones
Are gallstones dangerous?
Most people with gallstones experience no symptoms at all. With symptomatic gallstones, however, the major concern is that a gallstone will get lodged in the bile ducts and cause potentially serious complications.
Can gallstones go away without surgery?
Gallstones do not go away without surgery. However, most people live with gallstones without symptoms or health problems. When gallstones do cause symptoms, the near-universal treatment is to remove the gallbladder—stones and all.
Can you pass a gallstone?
Gallstones can and do pass through the bile ducts. Many are so tiny that they don’t cause a problem. The danger, however, is that a large gallstone could lodge in the bile ducts and cause serious and even life-threatening complications.
Can you take medicine to get rid of gallstones?
There are medicines that dissolve gallstones, but they are usable in only one out of ten cases. Called gallstone dissolution agents, these medications are effective but the gallstones usually return.
What happens if gallstones are left untreated?
If symptomatic gallstones are not treated, there is a risk of potentially severe complications including infection. Fortunately, most gallstones do not produce symptoms and will most likely never cause complications.
What is the best painkiller for gallstones?
The standard pain medications for biliary colic (bile duct pain) or acute cholecystitis (bile duct inflammation) caused by a gallstone are prescription nonsteroidal anti-inflammatory drugs (NSAIDs).
What can dissolve gallstones?
Prescription medications that “dissolve” gallstones actually do nothing of the kind. Ursodiol and similar drugs lower the cholesterol content in the gallbladder, allowing cholesterol crystals and stones to slowly dissolve. Unfortunately, these medications work in only a small fraction of cases and are not very effective in the long term.
What foods can trigger a gallbladder attack?
Eating causes the gallbladder muscles to contract to squeeze out bile acids into the intestines. A painful gallbladder attack occurs when those contractions push a gallstone in front of the cystic duct—the gallbladder’s “exit.” The stone effectively blocks the way, causing sharp, continuous pain. Some foods, such as fatty foods, fried foods, processed foods, dairy products, and eggs may cause stronger gall bladder contractions than others. If there are gallstones in the bladder, these foods are more likely to trigger a gallbladder attack.
What side should I sleep on with gallstones?
The gallbladder is on the right side of the body. However, the cystic duct—the gallbladder’s “exit” door—is on the left side of the gallbladder. Gallbladder attacks happen whenever a gallstone blocks the cystic duct, so you want gallstones to roll around on the right side of the gallbladder. If you have gallstones—with or without symptoms—avoid sleeping on your left side.
Does cranberry juice help gallstones?
Cranberry juice has long been touted as a natural way to “dissolve” kidney stones, so many health writers claim cranberry juice can dissolve gallstones, as well. However, there is no scientific evidence that cranberry juice helps shrink kidney stones. There is even less evidence that cranberry juice has any effect on gallstones, an entirely different phenomenon involving different substances.
Does drinking water help with gallstones?
It is certainly true that dehydration can contribute to gallstone formation. People with gallstones should undoubtedly drink six to eight glasses of water a day to maintain normal hydration. But does drinking lots of water help with gallstones? The answer is maybe, but not for the reasons you think. First, drinking more water than you need does not notably increase water in the gallbladder. So, drinking excess water will not “dissolve” or pass gallstones. However, drinking a pint of water—about two full glasses—at a single sitting can stimulate the gallbladder to empty its contents, a good way to help prevent gallstones.
Can I take ibuprofen for gallbladder pain?
Over-the-counter ibuprofen may help with gallbladder pain, but healthcare providers typically turn to prescription pain relievers to manage the acute pain of a gallbladder attack.