Gallstones are a common digestive problem that make life difficult for many people due to unpleasant symptoms such as abdominal cramps and pain. Although many people live with gallstones without experiencing any symptoms, stones that cause symptoms require treatment. Fortunately, thanks to advances in medical science, there are now numerous modern and minimally invasive procedures available for removing gallstones and treating related problems. This article will help you understand what gallstones are, what symptoms they can cause, and what modern treatment options are available. Our aim is to provide comprehensive and clear information that will help allay any fears you may have about these procedures.
From Endomedix Gastroenterology Centre Our specialists are committed to using the latest diagnostic and therapeutic methods to ensure that our patients receive the highest possible standard of care.
What exactly is a gallstone?
Az epekő (orvosi nevén cholelithiasis) egy szilárd, kristályos képződmény, amely az epehólyagban vagy az epeutakban alakul ki az epe összetevőiből. Az epe egy folyadék, amelyet a máj termel, és az epehólyagban tárolódik. Fő feladata a zsírok emésztésének segítése. Ha az epe összetevőinek – koleszterin, epesavak, bilirubin – egyensúlya felborul, az epe besűrűsödhet, és apró kristályok, majd idővel nagyobb kövek képződhetnek.
Types of gallstones
Gallstones can be classified into several groups based on their composition:
- Cholesterol stones: This is the most common type, accounting for approximately 75% of all gallstones. They are yellowish-white in colour and form when the bile is overly saturated with cholesterol.
- Pigment stones: These are darker in colour, black or brown, and are caused by an excessive amount of bile pigment (bilirubin). Black pigment stones (20%) usually form in the gallbladder, whilst brown pigment stones (5%) tend to form in the bile ducts, often as a result of infections.
- Rare stones: Stones consisting of calcium carbonate or calcium fatty acid precipitates occur in very small proportions (approx. 0.5%).
Risk factors
There are a number of factors that can increase the risk of gallstone formation. It is important to note that these do not necessarily lead to illness; they merely increase the likelihood of developing the condition.
- Age and sex: The risk increases with age. The condition is approximately two to three times more common amongst women, particularly in those aged 40 and over.
- Genetics: There is a high incidence of this condition running in families, which suggests a genetic predisposition.
- Lifestyle and nutrition: A Western-style diet, which is high in fat and cholesterol but low in fibre, promotes the formation of kidney stones.
- Overweight and obesity: Obesity increases cholesterol levels in the bile.
- Rapid weight loss: Sudden weight loss or fasting can also disrupt the composition of bile.
- Pregnancy and hormone treatments: Female sex hormones (oestrogen) can raise cholesterol levels and reduce gallbladder motility.
- Certain illnesses: Certain conditions, such as diabetes, liver cirrhosis, Crohn’s disease or non-alcoholic fatty liver disease, also increase the risk.
Symptoms and diagnosis of gallstones
Az epekövek sok esetben (az érintettek 70-75%-ánál) nem okoznak panaszt, ezeket nevezzük „néma” köveknek. Ilyenkor a követ gyakran egy más okból végzett hasi ultrahangvizsgálat során fedezik fel véletlenül.
Ha azonban az epekő elmozdul és elzárja az epehólyag kivezető csövét vagy az epeutakat, jellegzetes tünetek jelentkezhetnek.
Typical symptoms
- Biliary colic: This is the most characteristic symptom. A sudden-onset, severe, cramp-like pain in the upper right side of the abdomen or in the middle of the abdomen. The pain may radiate into the back, towards the shoulder blade or into the right shoulder. The cramp usually occurs after a high-fat meal and can last from a few minutes to several hours.
- Associated symptoms: Biliary colic is often accompanied by nausea, vomiting, sweating and abdominal bloating.
Signs of complications
If the stone causes a persistent blockage, more serious complications may arise. The symptoms of these are as follows:
- Acute cholecystitis: Persistent, severe pain, fever, chills. This is when the wall of the gallbladder becomes inflamed.
- Jaundice (icterus): If the stone blocks the common bile duct, bile cannot be released into the intestine. The skin and the whites of the eyes turn yellowish, the urine becomes dark, and the stools become pale.
- Pancreatitis (inflammation of the pancreas): An obstruction at the junction of the bile duct and the pancreatic duct can lead to a life-threatening condition: acute pancreatitis.
The diagnostic process
Diagnosing gallstones is usually straightforward and painless. A gastroenterologist may suspect the problem based on the symptoms alone.
- Abdominal ultrasound scan: Ez az elsődleges és legfontosabb diagnosztikai módszer. A vizsgálat során hanghullámok segítségével alkotnak képet a hasi szervekről, így az epehólyagról is. Az ultrahang megbízhatóan kimutatja a köveket, az epehólyag falának megvastagodását vagy a gyulladás jeleit.
- Laboratory tests: A blood test can be used to check liver and bile function levels, as well as inflammatory markers, which may indicate complications.
- Endoscopic ultrasound (EUS) or MRCP: If the ultrasound does not provide a clear result, or if there is a suspicion of gallstones, these specialised imaging techniques provide a more accurate picture of the bile ducts.
From Endomedix Gastroenterology Centre modern ultrahang-készülékekkel és tapasztalt szakemberekkel biztosítja a gyors és pontos diagnózist.
Modern treatment options for gallstones
The choice of treatment depends on whether the stone is causing symptoms and, if so, how severe they are. Asymptomatic, „silent” stones generally do not require treatment; regular medical check-ups are sufficient. However, if symptoms are present, treatment is essential to relieve pain and prevent serious complications.
Conventional surgical procedure: Cholecystectomy
The definitive treatment for symptoms caused by gallstones is the surgical removal of the gallbladder (cholecystectomy). Nowadays, in the vast majority of cases, this procedure is carried out using a laparoscopic technique, which is much less invasive for the patient than traditional open abdominal surgery.
- Laparoscopic cholecystectomy: A sebész néhány apró, 0,5-1 cm-es metszésen keresztül vezeti be a hasüregbe a kamerát (laparoszkóp) és a szükséges sebészeti eszközöket. A hasüreget szén-dioxiddal töltik fel, hogy a szervek jól láthatóvá váljanak. A beavatkozás előnyei:
– Kisebb műtéti terhelés és fájdalom.
– Gyorsabb felépülés és rövidebb kórházi tartózkodás.
– Minimális hegesedés, szebb esztétikai eredmény.
- Open surgery: Nowadays, this is only rarely necessary – for example, in cases of severe inflammation, scarring or anatomical abnormalities. In such cases, a larger abdominal incision is made below the right costal margin.
Endoscopic procedures: The role of ERCP
If the stone is not located in the gallbladder but in the common bile duct and is causing an obstruction, a specialised endoscopic procedure known as ERCP (endoscopic retrograde cholangiopancreatography) offers a solution. This procedure serves both diagnostic and therapeutic purposes.
- The ERCP procedure: The patient is under anaesthesia. The doctor inserts a flexible endoscope through the mouth, down the oesophagus and through the stomach into the small intestine, right up to the opening of the bile duct. By injecting a contrast agent, the bile ducts are made visible on an X-ray screen.
- Stone removal: If a stone is found, the doctor will make a small incision at the opening of the bile duct (this is called a sphincterotomy) and then remove the stone from the bile duct using a special basket or balloon.
- Stent placement: If necessary, a thin plastic or metal tube (stent) may also be inserted into the bile duct to ensure that bile can flow freely.
Az ERCP egy rendkívül hatékony és kíméletes módszer az epeúti kövek eltávolítására, amellyel elkerülhető egy nagyobb műtét. Az Endomedix Gastroenterology Centre magasan képzett szakorvosai nagy tapasztalattal végzik ezt a beavatkozást.
Other modern methods
Although they are used less frequently, there are other methods which may offer an alternative in certain cases.
- Medical lithotripsy: Certain medicines (e.g. ursodeoxycholic acid) are capable of dissolving smaller, pure cholesterol stones. However, treatment is a lengthy process (it can take months or even years), and the stones often reform once treatment is stopped. It is therefore only an option for patients for whom surgery would be too risky for some reason.
- Extracorporeal shock wave lithotripsy (ESWL): High-energy shock waves are used to break gallstones into smaller pieces, which can then be passed along with the bile. This method is now rarely used in the treatment of gallstones because it is less effective and stone recurrence is common.
Management strategies in different situations
The most appropriate treatment method is always chosen on a case-by-case basis, taking into account the patient’s condition, the severity of their symptoms and the location of the stones.
- Asymptomatic gallstones: Treatment is not usually necessary; only regular medical monitoring is required.
- Gallstones causing symptoms (biliary colic): The definitive treatment is laparoscopic cholecystectomy, which is usually carried out at a scheduled (elective) time.
- Acute cholecystitis: It requires urgent hospital treatment. Treatment consists of antibiotics and surgery to be carried out as soon as possible. In patients in a critical condition, the contents of the gallbladder are first drained through a thin tube (drainage), and the operation is only performed once the patient’s condition has stabilised.
- Bile duct obstruction with jaundice: The recommended procedure is ERCP, which is used to remove the stone from the bile duct. As there are usually further stones remaining in the gallbladder, it is also recommended that a gallbladder removal operation be carried out at a later date.
What can we do to prevent it?
Although we cannot influence our genetic predisposition, we can reduce the risk of gallstone formation through lifestyle changes.
- Healthy eating: Eat foods rich in fibre (wholemeal grains, vegetables, fruit) and healthy fats (olive oil, fish). Avoid foods high in saturated fats and refined carbohydrates.
- Weight control: Maintain your ideal weight. If you are overweight, aim for slow, gradual weight loss (0.5–1 kg per week).
- Regular physical activity: Physical activity helps with weight management and improves digestion.
- Adequate fluid intake: Make sure you drink enough water throughout the day.
Summary: Seek expert advice!
Gallstones are a common problem that can cause severe pain and complications, but thanks to modern medicine, they can now be treated effectively and safely. Laparoscopic surgery and endoscopic procedures, such as ERCP, offer a gentle solution that ensures a quick recovery for most patients.
It is important that, if you experience symptoms suggestive of gallbladder colic, you do not hesitate to consult a gastroenterologist. Early diagnosis and the initiation of appropriate treatment are crucial in preventing more serious problems. The Endomedix Gastroenterology Centre Our highly qualified team of specialists and state-of-the-art facilities guarantee that you will receive the highest standard of personalised care, from diagnosis right through to the most advanced treatments. Don’t let pain and fear control your life – take a step towards better health!
