Gallstone

Gallstones or cholelithiasis, comes about when the components of bile: fatty acids and other lipids, cholesterol, bile salts, bilirubin, electrolytes and water, are imbalanced and out of proportion. If the concentration of these components changes, they may precipitate from solution and form gallstones. Frequently it is when cholesterol is imbalanced that stones arise. There are 2 main types of gallstones: cholesterol stones which are hard, crystalline stones that contain more than 50% cholesterol plus varying amounts of protein and calcium salts. They predominate (>85%) in the Western world. Pigment stones are less common and are composed of minerals such as calcium.

Approximately 10% of all adults have gallstones. The risk of developing gallstones tends to increase with age. Approximately one-fifth of men and one-third of women will eventually develop cholelithiasis. Heredity appears to play a part in the development of gallstones and there is frequently a family history of the disease. Women develop gallstones more commonly than men and at a younger age. Certain women are more at risk than others: Caucasian, middle aged, fertile females with an increased risk in pregnancy.

Other factors that increase the risk of developing gallstones include: being overweight, eating a diet high in dairy products and animal fats, being diabetic, and taking cholesterol-lowering medications.

The gall bladder can also contain ‘sludge’ which may not form into stones but still can be a factor in gall bladder disease. The sludge contains cholesterol, bile salts and the glycoprotein mucin. Sludge can be seen via ultrasound but not x-rays. Sludge can be caused the same things as stones, and can cause the same type of pain. Sludge can also be without pain and disappear.

Most patients (80%) with gallstones never develop symptoms. Problems, if they do occur, usually arise in the form of gall bladder or abdominal pain during the first 5 to 10 years. Complications are from stones obstructing: the cystic duct, leading to inflammation of the gallbladder (cholecystitis): this begins as a chemical inflammation and later may become complicated by bacterial invasion; or the common duct, causing gall bladder obstruction (cholestasis), sometimes accompanied by bacterial infection in the ductal system (cholangitis).

Symptoms of Gall Stones

Gall stones can create steady, severe pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours. The pain can be in the back between the shoulder blades or under the right shoulder. Belching, bloating, fullness and nausea after meals, especially fatty meals, are common, vomiting can also occur. Sometimes the pain from gallstones is so severe it may be mistaken for a heart attack.

Diagnosis and Pharmaceutical Interventions

Laboratory tests are usually normal. In 10-20% of cases, there may be a slight elevation of in blood chemistry of bilirubin, the liver biochemistry tests alkaline phosphatase, aminotransferases (AST and ALT) or gamma-glutamyl transpeptidase (GGT).

Between attacks the patient feels well. Liver biochemistry is normal. Over long periods the activity of the disease remains fairly constant. If having frequent episodes of gall bladder pain, the patient will probably continue to experience this pattern. The most common test used to diagnose gallstones is an ultrasound scan. Blood tests to check on the function of the pancreas may also be performed.

If it is suspected that gallstones are blocking the ducts a test called endoscopic retrograde cholangiopancreatography (ERCP) may be performed. This test involves inserting a long, flexible tube (an endoscope) down the oesophagus, through the stomach and into the small intestine. The endoscope has a light and a camera at its tip allowing the doctor to view the inside of the bowel. A special dye is injected through the endoscope into the bile duct allowing the outline of the ducts to be highlighted. Gallstones located in the ducts can often be removed during the ERCP procedure.

Treatments

Pharmaceutical interventions

In some incidences the medication can be Ursodiol is used to dissolve gallstones in patients who do not want surgery or cannot have surgery to remove gallstones. Ursodiol is also used to prevent the formation of gallstones in overweight patients who are losing weight very quickly. Ursodiol is a bile acid, a substance naturally produced by the body that is stored in the gallbladder. It works by decreasing the production of cholesterol and by dissolving the cholesterol in bile so that it cannot form stones. It dose not work on the stones themselves.

Surgery

Surgery may be an option discussed. It is a very common surgery, and may be in fact overused. Laparoscopic cholecystectomy – or ‘keyhole’ surgery. A number of small incisions are made through the skin, allowing access to a range of instruments. The gall bladder is removed through one of the incisions. Open surgery (laparotomy) – the gall bladder is accessed through a wider abdominal incision. Some of the factors that may predispose a patient to open surgery include scarring from prior operations and bleeding disorders. Some people may still experience pain and other symptoms after surgery, called postcholestectomy symdrome; in that case the situation may have been misdiagnosed.

Lifestyle and Dietary Modifications

Being overweight greatly contributes to the formation of gallstones although both obesity and rapid weight loss are both considered risks for gall stones. Obesity is more of a problem because of the high fat, high sugar and processed foods one may be more inclined to eat. A whole food diet that is high in fibre can decrease gall bladder problems as it promotes the bowel transit time and reduces cholesterol.

Exercise can reduce the risk of gallstones by slow and steady weight loss

Oral contraceptives increase the risk of gallstones, as estrogen is thought to suppress synthesis of bile acids and increase the cholesterol.

Eliminate foods that cause an allergic response or to which there is sensitivity (fast, use an elimination diet, or allergy test to isolate such foods) the most common foods are eggs, pork and onions. Many people have read or even tried gall bladder flushes with olive oil and lemon juice. The combination of these two ingredients actually creates the stones that appear to be gall stones; they are soft saponified spheres of emulsified oil and bile salts, formed from the overload of oil. They are soap, and will melt. True gallstones are hard and do not melt. Another problem with the flushes is the risk of really moving a stone, and it getting caught in the gall bladder duct, resulting in severe pain and a trip to the emergency department.

Nutritional Factors Shown to be Beneficial

Betaine HCl

Hypochlorhydria, or low stomach acid, is common in patients with gallbladder stones. When stomach acid is low there is incomplete emptying of the contents of the stomach into the small intestine, which is where the bile enters the intestines. By improving digestion in the stomach, the flow of bile from the gall bladder may be regulated better and risk of gall bladder stones reduced.
Dose: 500 mg

Lecithin

Lecithin is also called phospatidylcholine. It is an emulsifying agent, meaning it can mix fats and water, and improves the solubility of bile.
Dose: 100 mg three times a day

Taurine

Taurine is incorporated into one of the most abundant bile acids, chenodeoxychloic acid where it serves to emulsify dietary lipids in the intestine, promoting digestion.
Dose: 500 mg – 3 gram in divided doses a day

Artichoke leaf (Cynara scolymus)

Artichoke leaves, not the flower parts that are commonly eaten as food, have a liver protecting function and can help lower cholesterol.
Dose: 500 mg twice a day