They can remain silent for a long time, and maybe you discover that you have them only by chance, during an ultrasound to which you have undergone for a completely different reason. But when they decide to make themselves felt, gallbladder stones can be very painful.
Unfortunately, there are not many alternatives to treat them: when the time comes to do so, you must almost always undergo surgery.
At the same time, though, a healthy lifestyle could help prevent them.
Gallbladder stones: what they are and why they are formed
Gallbladder stones are deposits that form within the small pear-shaped organ located just below the liver, also known as a gallbladder, which functions as a pouch in which bile accumulates.
The latter, produced by the liver, is a fluid that participates in the process of digestion of lipids at the level of the small intestine. Inside there are several substances, including:
- bile salts, which help solubilize fats to digest them
- lecithin, a substance capable of solubilizing cholesterol
- cholesterol and bilirubin, the pigment resulting from the degradation of red blood cells that gives bile its typical yellowish-green color.
When the composition of bile is not balanced, one or more of its components can precipitate forming so-called stones, deposits that can become as large as golf balls.
Depending on the substances that settle it is possible to distinguish different types of gallbladder stones. The most frequent are cholesterol stones, the formation of which may be due to:
- excessive cholesterol production by the liver (the main cause of gallbladder stones in obese people)
- a defect in the conversion of cholesterol into bile acids caused by the reduced activity of an enzyme necessary for this process (more frequent cause in non-obese people) or associated with the intake of estrogen hormones
- disruption of bile circulation between the liver and intestines.
Bilirubin stones, on the other hand, are caused by its excess in the bile; Also known as “pigmented stones“, they can be of two types:
- blacks, which are formed most often in people with cirrhosis or with chronic conditions that lead to degradation of red blood cells, such as thalassemias and Mediterranean anemia
- brown, which form in the bile ducts in the presence of bacterial infections. In fact, bacteria can precipitate bilirubin in the form of calcium salts.
Finally, gallstones can have a mixed composition and contain varying percentages of cholesterol, bilirubin and other substances, such as calcium carbonate, calcium phosphate and calcium palmitate.
Generally, the formation of gallstones is preceded by the appearance of biliary mud (or sand), a substance formed by thickened mucoproteins in which cholesterol crystals are trapped.
Gallbladder stones: risk factors
Gallbladder stones are 4 to 10 times more frequent in old age, thanks to the reduction of the activity of the enzyme for the synthesis of bile acids associated with aging.
High concentrations of proteins, lipids and calcium in bile are all risk factors for their formation. But they are not the only ones.
Another condition that can contribute to their appearance is the reduction of motility of this small organ. In fact, if the gallbladder contracts sufficiently, it is expected to be able to regularly eliminate deposits of microscopic size without particular consequences. Reduced motility could instead predispose to the formation of stones of significant size. In addition, reduced bowel motility can also be a risk factor for cholesterol stones.
The problem is more frequent in women, who in childbearing age are almost 2 times more prone to this disorder than their male peers. This difference, although to a lesser extent, persists even after menopause, and tends to decrease with advancing age. At its base there seem to be estrogens. For this reason, pregnancy, taking contraceptives based on these hormones or hormone therapy are considered risk factors for the appearance of gallbladder stones.
Genetics also seems to play a role. This is suggested by the greater prevalence of the problem in some populations, such as some Native American tribes.
Finally, risk factors for the formation of gallbladder stones are:
- obesity, especially in the case of women (even more so in younger ones), due to the increase in cholesterol synthesis by the liver
- diabetes, particularly in cases of increased triglycerides, diabetic neuropathy and melatonin deficiency
- rapid weight loss, which increases bile production by the liver and is associated with mobilizing cholesterol from fat deposits and, sometimes, reducing gallbladder contractions
- a sedentary lifestyle (on the contrary, physical activity promotes weight control and improves metabolic parameters associated with obesity and gallbladder stones)
- certain medications (such as fibrates and proton pump inhibitors).
As for biliary mud, it can form during pregnancy, in fasting conditions, after a prolonged period of artificial feeding, following rapid weight loss or due to the intake of certain antibiotics.
Gallbladder stones: when symptoms occur
The first symptoms of gallbladder stones can appear already with the formation of bile sludge. In addition to triggering pain, its accumulation can also lead to cholecystitis (i.e. inflammation of the gallbladder) or acute pancreatitis (inflammation of the pancreas).
In most cases, however, gallbladder stones are totally asymptomatic. In the event that they occur, generally the trigger is the occlusion of a duct by stones.
Typical are recurrent episodes of pain in the right upper quadrant of the abdomen or at the mouth of the stomach.
The discomfort can be associated with nausea, vomiting and loss of appetite, and tends to increase steadily for hours, sometimes extending to the back (between the shoulder blades or under the right shoulder).
Attacks often occur after a particularly high-fat meal, almost always at night.
As in the case of biliary sludge, even real stones can cause acute cholecystitis, often with infection by intestinal bacteria (especially Escherichia coli and Bacteroides).
Inflammation is associated with severe abdominal pain, also in this case localized in the upper right part; Other possible symptoms are nausea, vomiting, fever and increased white blood cells. You may also have bile duct infections.
Even the passage of stones into the common bile duct (choledochus) can remain asymptomatic or trigger pain in the upper right part of the abdomen or at the mouth of the stomach. Obstruction may manifest as jaundice or, if it involves the main pancreatic duct, acute pancreatitis.
Finally, stones can end up in the duodenum or small intestine, causing obstructions here too.
How to cure gallbladder stones
In the absence of symptoms, no treatment may be necessary. However, intervention is recommended in most cases where stones begin to manifest: the pain may reappear along with serious complications.
In addition, the treatment is also recommended for people with obesity who will undergo bariatric surgery due to the strong weight loss that should follow (which, as mentioned, is a risk factor for gallstones).
The approach is mostly surgical and involves the removal of the gallbladder (cholecystectomy). The surgery can be conducted either by performing a large incision in the abdomen or by laparoscopy, a less invasive technique that requires smaller incisions and that allows to reduce both convalescence times and post-operative discomfort.
A possible alternative is bile acid drugs that promote the dissolution of stones. However, the therapy lasts many months, is not particularly effective in case of stones with a diameter of more than half a centimeter and is associated with a rather high risk of recurrence.
Fragmentation of stones with extracorporeal shock waves is used only in rare cases.
The role of nutrition in gallbladder stones
Nutrition can also play a role in the formation of gallbladder stones. It is known, for example, that dietary fiber could protect against stone formation by increasing the speed of intestinal transit and reducing the formation of bile acids, such as deoxycholic acid, which have been associated with increasing the amount of cholesterol present in bile.
In the case of diets that lead to rapid weight loss, however, the intake of an adequate dose of fat could help limit the stasis of the gallbladder, thus reducing the risk of stones.
In general, a healthy diet, rich in fruits and vegetables, whole grains, nuts, legumes, low-fat dairy products and spices could help keep gallstones away compared to a diet rich in processed meats, refined grains, sugary drinks, red meat, high-fat dairy products, eggs, salt and solid fats.
Refined grains, fats and reduced fiber intake seem to induce stone formation. Conversely, antioxidants, magnesium, vitamin C, omega 3 and high fiber intake seem to exert a protective role.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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