Gallstones (Cholelithiasis) Treatment in Delhi, India

Gallstones are solid deposits that can develop in the gallbladder, a small organ responsible for storing bile. Bile is a digestive fluid produced in the liver and released into the small intestine (duodenum) to aid in digestion when an individual eats.

There are two main types of gallbladder stones:

• Cholesterol Stones: These stones are usually yellow-green and account for approximately 80% of gallstones. Despite the name, cholesterol stones are not directly related to cholesterol levels in the blood. They are formed when there is an imbalance in the components of bile, including cholesterol, bile pigments, and calcium salts.

• Pigment Stones: These are smaller and darker and are composed primarily of bilirubin. They form when there is an excess of bilirubin in the bile, often due to conditions such as the destruction of red blood cells (Haemolysis) or liver disease.

Gallstones can be triggered by a variety of factors, making it essential to understand the potential causes and risk factors. Here are some common contributors:

• Obesity and rapid weight loss: Being overweight or rapid weight loss may be a risk factor for developing gallstones.

• Genetics: A family history of gallstones can increase an individual's susceptibility to developing them.

• High levels of bilirubin in the blood: Conditions that cause an excess of bilirubin, such as hemolysis, can increase the risk of pigment stone formation.

• Hormonal imbalances: Hormonal changes occur during pregnancy or with certain medications like birth control pills or oestrogen replacement therapy, which can increase the risk of gallstones.

• Inflammatory bowel disease: Inflammatory bowel diseases such as Crohn's disease and ulcerative colitis can increase the risk of gallstone formation.
• Metabolic disorders: Metabolic disorders like diabetes can contribute to developing gallbladder stones.
• Prolonged fasting or a diet high in fat and cholesterol: Certain dietary factors can increase the risk of gallstone formation.

The symptoms of gallbladder stones can vary, and some people may remain asymptomatic. However, if one is symptomatic, the following symptoms may occur:

• Pain: Sharp and sudden or dull ache in the upper right abdomen or upper back

• Nausea or vomiting: These symptoms may occur along with abdominal pain.

• Indigestion or bloating: Gallbladder stones can cause indigestion or bloating after eating.

• Fatigue: People with gallbladder stones may feel tired or weak due to pain and discomfort.

• Jaundice: In some cases, gallbladder stones can block the bile duct, causing yellowing of the skin and eyes.

• Clay-coloured stools: Complicated gallbladder stones can cause the stools to turn pale or clay-coloured.

• Fever or chills: Inflammation of the gallbladder or infection of bile can lead to fever or chills.

• Loss of appetite: People with gallbladder stones may experience a decreased appetite due to pain and discomfort.
• Sweating: Some individuals may experience sweating along with abdominal pain.
• Rapid heartbeat: The pain and discomfort caused by gallbladder stones can also lead to a rapid heartbeat.

Complications of gallbladder stones can include:

• Acute cholecystitis: Inflammation of the gallbladder caused by a blockage in the bile ducts, leading to severe abdominal pain, nausea, vomiting, and fever.

• Pancreatitis: Inflammation of the pancreas, which can occur if a gallstone obstructs the bile duct and blocks the flow of enzymes from the pancreas, causing severe abdominal pain, nausea, vomiting, and fever.

• Intestinal obstruction: A gallstone can become lodged in the small intestine, causing blockage and difficulty passing stool.

• Jaundice: If a gallstone blocks the common bile duct, it can cause jaundice, characterised by yellowing of the eyes and skin.

• Septicemia: A severe complication that can occur if a gallstone becomes infected and spreads bacteria to the bloodstream, causing symptoms like fever, chills, and a rapid heartbeat.

• Bile duct injury: Surgical removal of gallstones carries a risk of injury to the bile ducts, leading to complications such as bile leakage or infection.
• Recurrent gallstones: After gallbladder removal, individuals may develop gallstones again in the bile ducts.
• Chronic gallbladder disease: Long-term inflammation of the gallbladder can cause chronic discomfort, as well as an increased risk of gallbladder cancer.

Diagnosing gallbladder stones involves a combination of imaging tests and physical examination. Common diagnostic methods include:

• Ultrasound: This is the most common imaging test, which uses high-frequency sound waves to create detailed images of the gallbladder and diagnose gallstones.

• CT scan: A CT scan uses X-rays to detect radio-opaque small stones or stones in difficult-to-see areas.

• MRI: Although not typically the primary diagnostic tool, an MRI can create detailed images of the gallbladder, bile ducts, and surrounding organs using a magnetic field.

• HIDA scan: This test involves using a small amount of radioactive material and a special camera to create images. It can detect blockages or other issues with the gallbladder.
• Blood test: It can be used to check for signs of infection, inflammation, or other issues with the gallbladder. These may include tests for bilirubin, alkaline phosphatase, and amylase.
• Physical examination: The doctor may check for signs of inflammation in the upper right side of the abdomen, which can indicate complicated gallbladder stones.

Most people with gallstones will not need treatment. However, if the gallstones cause problems, it is advised to consult a gastroenterologist. Treatment options for gallbladder stones depend on factors such as the size and location of the stones and the individual's overall health. They include:

Medications 

Medications may be prescribed to prevent stones from forming in high-risk individuals. Ursodeoxycholic acid and chenodiol are commonly used for this purpose.

Surgery

Gallbladder removal surgery (cholecystectomy) is a common procedure. When selecting a facility for this procedure, ensuring that they employ the best gallbladder surgeons can be beneficial. 

There are two types of cholecystectomy:

• Laparoscopic cholecystectomy: This is a modern technique and is commonly referred to as laparoscopic gallbladder surgery. The gallbladder stone specialist makes a few small incisions in the patient's abdomen, uses a lighted device to check for gallstones, and removes the gallbladder. Patients can often go home the same day or the next day if there are no complications.

• Open cholecystectomy: This surgery is performed when the gallbladder is inflamed, or if problems arise during a laparoscopic procedure.

Other Treatments

• Oral dissolution therapy: This involves using medications like ursodiol and chenodiol to break up gallstones. These medications contain bile acids and work best for cholesterol stones, but it may take several months or years to be effective.
• Shock wave lithotripsy: Shock wave lithotripsy uses shock waves to break gallstones into smaller pieces.

Percutaneous drainage of the gallbladder: This involves inserting a sterile needle into the gallbladder to draw out bile. A tube may be inserted for additional drainage. This is usually considered when other options are not suitable for the individual.

There is no definitive preventive strategy for gallstones, though adopting a healthy lifestyle may delay their progression:

• Maintain a healthy diet
• Maintain a healthy weight
• Avoid crash dieting
• Limit processed foods
• Get regular exercise
• Limit alcohol consumption
• Take vitamin C supplements
• Consult a doctor if there is a family history of gallstones

• Get enough sleep

• Consider taking ursodeoxycholic acid (UDCA) supplements

It is recommended to consume certain foods in moderation:

• High-fat foods: Foods such as cheese, red meat, and fried foods should be consumed within limits.
• Processed foods: Packaged snacks and frozen meals often contain high levels of added sugars and unhealthy fats, which can increase the risk of gallstone formation.
• Dairy products: Consuming too much dairy, like whole milk and cheese, can contribute to the formation of gallstones.
• Refined carbohydrates: Foods like white bread, pasta and sugary drinks can increase blood sugar levels rapidly, which can worsen gallstone disease.

Do all gallstones need to be removed?

A: No, not all gallstones need to be removed. The decision to remove gallstones depends on whether they are causing symptoms or complications. Asymptomatic gallstones may not require treatment, while symptomatic gallstones or those causing complications usually necessitate removal, typically through cholecystectomy (surgical removal of the gallbladder).

Is gallstone removal surgery painful? 

A: Gallstone removal surgery can cause discomfort and pain, but it is usually managed with pain relief medication.

What is the recovery period after gallstone surgery? 

A: The recovery period after gallstone surgery varies, but often takes a few weeks to return to normal activities.

What are the potential consequences of leaving gallstones untreated? 

A: Leaving gallstones untreated can lead to complications like infection, inflammation, or bile duct blockage.

Why are women more susceptible to developing gallstones? 

A: Women are more at risk of developing gallstones due to hormonal factors, including oestrogen.

Is surgery a necessary treatment for cholelithiasis?

A: Surgery is often the most common and effective treatment for cholelithiasis. However, whether surgery is necessary depends on several factors, including the patient's symptoms, the size and location of the gallstones, and the individual's overall health.

Can gallstones resolve without surgical intervention? 

A: Yes, in some cases, gallstones can resolve without surgical intervention. The treatment approach depends on the size and type of gallstones, as well as the presence and severity of symptoms. 

Are there any dietary changes after gallstone surgery?

A: Yes, dietary changes are often recommended after gallbladder surgery, especially after a cholecystectomy. These changes are aimed at minimising digestive discomfort and ensuring proper fat digestion.

Are cholelithiasis and gallstones the same?

A: Yes, cholelithiasis and gallstones are closely related and often used interchangeably to refer to the same medical condition.

Reviewed by Dr. Nishant Nagpal, Associate Director-  Gastroenterology, Hepatology & Endoscopy on 28-Feb-2024.

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