Gallstones affect approximately 15 per cent of the population and have become a lot more common in recent years, but in the majority of cases they don’t have any symptoms and don’t need to be treated.
Gallstones are formed when the chemicals that make up bile (cholesterol, bile salts, and bilirubin) become imbalanced and harden into tiny crystals, which gradually grow into solid stones. Sometimes one or several stones will form at the same time.
Bile is a fluid produced by your liver, collected and stored in the gallbladder and it carries toxins and waste products out of the body through bile ducts, helping you digest fat and absorb fat-soluble vitamins A, D, E and K.
Most gallstones are made from cholesterol. Bile usually dissolves cholesterol, but if there’s too much to break down then hard stones may develop. Therefore, a diet high in cholesterol, saturated fats, refined sugar and low fibre may increase the risk of gallstones.
Gallstones may also form because of high levels of the waste product bilirubin, produced when the body breaks down red blood cells.
Gallstones can occur when bile becomes more concentrated and the flow is reduced due to fasting or liver disease.
Most people with gallstones have no symptoms, although vague ones such as indigestion and intolerance to fatty foods may occur.
If gallstones block any ducts carrying bile to the small intestine, it can cause severe abdominal pain, known as biliary colic. This is caused by the gall bladder contracting to try and expel the stone. Pain is felt in the right upper or centre of your abdomen, where it may radiate to your back and shoulder blades. The pain can last from one to five hours (sometimes longer) and is usually brought on by eating fatty foods.Other symptoms include excessive sweating, nausea and vomiting.
In a small amount of cases, gallstones can cause more serious conditions such as pancreatitis, where the pancreas becomes inflamed. Symptoms include yellowing of the skin (jaundice), fever and abdominal tenderness.
Your doctor may be able to diagnose gallstones from your symptoms, but they’re often diagnosed during tests for other conditions. Blood tests may be taken, such as liver function tests, to see if there’s any infection or inflammation present. If gallstones are suspected an abdominal ultrasound examination may be done to confirm the diagnosis.
Further tests such as an MRI scan, which uses magnetic fields and radio waves, to look for gallstones in the bile ducts; a cholangiography procedure, which uses dye that shows up on X-rays which can show any abnormality in your bile or pancreatic system; and a CT scan which may identify any complications from gallstones.
Who gets gallstones?
You’re more likely to be at risk if you’re female because the female sex hormone oestrogen increases cholesterol in the bile and progesterone slows the gallbladder from emptying.
There's an old saying that gallstones happen to people with all the Fs - (fair, fat, female, fertile and forty) and experts say there is a degree of truth in this, as gallstones are more common in women who are overweight who have had children. However, gastroenterologists say it is now much more common for younger people to get gallstones.
Pregnancy, being overweight, rapid weight loss, increasing age and having diabetes all increase the risks.
Gallstones with no symptoms don't need treating. It may be possible to manage symptoms with painkillersand by avoiding foods or drink that trigger symptoms.
In some cases, the gallbladder may be removed by keyhole surgery called laparoscopic cholecystectomy, where some small cuts are made in the stomach and a laparoscope (a long thin telescope with a tiny camera and a light at the end) removes the gallbladder.
If this surgery isn’t possible, open surgery may be required, where one large cut is made. The gallbladder isn’t an essential organ, so it’s possible to live without one.
An endoscopic retrograde cholangio-pancreatography is a procedure that can remove gallstones from the bile duct by a flexible endoscope, so surgery isn’t needed.