Gallstones are a common digestive problem that affects many people, yet we know very little about them. Many people live for years without any symptoms, whilst for others, sudden, excruciating pain draws attention to the condition. This uncertainty, combined with a fear of possible surgery, fills many people with anxiety. The aim of our article is to set the record straight: we’ll explain the symptoms of gallstones in detail, the causes behind their formation, and, most importantly, provide expert advice on how to prevent them. We’ll explain when to see a doctor and what modern diagnostic and treatment options are available for Endomedix Gastroenterology Centre with the help of our experts, so that you too can get through this period with as little inconvenience as possible.
What exactly is a gallstone?
Gallstones are hardened deposits that form in the gallbladder. The gallbladder is a small, pear-shaped organ situated beneath the liver. Its main function is to store and concentrate the bile produced by the liver, which plays a key role in the digestion of fats.
Bile consists of several components, including cholesterol, bilirubin (a breakdown product of red blood cells) and bile acids. If the balance of these substances is disrupted – for example, if there is too much cholesterol or bilirubin – the bile fluid can become supersaturated, and tiny crystals may precipitate out of it. Over time, these crystals clump together and grow, forming gallstones of various sizes and compositions.
We distinguish between two main types:
- Cholesterol stones: These are the most common, accounting for around 80% of cases. They are yellowish in colour and consist mainly of insoluble cholesterol.
- Pigment stones: These are darker in colour – brown or black – and form when the bile contains too much bilirubin. Certain liver diseases or disorders of the blood-forming system may increase the risk of this type.
The stones can range in size from a grain of sand to as large as a golf ball. There may be a single large stone or many small ones in the gallbladder.
Risk factors for the development of gallstones
Anyone can develop gallstones, but certain factors increase the risk. It is important to be aware of these, as they may also be significant in terms of prevention.
Factors beyond our control:
- Age: The risk of gallstones increases with age, particularly for those over 40.
- Female: Gallstones are two to three times more common in women, which can be explained by the effect of female sex hormones, particularly oestrogen, on the gallbladder. Oestrogen increases the cholesterol content of bile and reduces the motility of the gallbladder.
- Genetic predisposition: If there is a family history of gallstones, there is a greater chance of developing the condition.
Factors that can be influenced and lifestyle-related causes:
- Obesity: Being overweight is one of the most significant risk factors. It increases the liver’s production of cholesterol, which saturates the bile.
- Rapid weight loss: Rapid weight loss following drastic diets or gastric bypass surgery can also lead to the formation of gallstones. In such cases, the liver releases extra cholesterol, and the gallbladder empties less frequently.
- Western-style diet: A diet high in fat and cholesterol but low in fibre promotes the formation of gallstones.
- A sedentary lifestyle: A lack of physical activity can contribute to obesity and slow down digestive processes, including the secretion of bile.
Medical conditions and medicines:
- Pregnancy and childbirth: The risk increases due to hormonal changes during pregnancy.
- Certain medicines: Medicines containing oestrogen (e.g. contraceptives, hormone replacement therapy) and certain cholesterol-lowering drugs (fibrates) may increase the risk.
- Other diseases: Diabetes, insulin resistance, Crohn’s disease, non-alcoholic fatty liver disease and coeliac disease have also been linked to gallstones.
What symptoms might indicate gallstones?
It is important to note that the majority of people with gallstones – around 70–75% – are completely asymptomatic. This is known as „silent gallstones”. In many cases, their presence is only discovered during an abdominal ultrasound scan carried out for another reason. Symptoms usually occur when a stone moves and blocks the bile duct.
The most common symptom: biliary colic
A biliary colic is the most common and most characteristic symptom of gallstones. It is a sudden-onset, intense, cramping pain that typically occurs in the upper right part of the abdomen, beneath the right rib cage or in the epigastric region.
- The nature of the pain: The pain gradually intensifies, reaching its peak in around 15 minutes, and can be extremely agonising. The patient is often restless and unable to find a position that alleviates their symptoms.
- Radiation: The pain often radiates into the back, towards the right shoulder blade, between the shoulder blades or into the right shoulder.
- Duration: A typical biliary colic attack can last from 30 minutes to several hours. If the pain persists for more than 3 hours, this may indicate a complication, such as cholecystitis.
- Underlying causes: Stomach cramps are often triggered by a fatty, heavy meal, but they can also occur at night, even whilst at rest.
- Accompanying symptoms: As well as pain, nausea, vomiting, bloating and chills or sweating are common.
Other possible symptoms and complications
If a gallstone causes a persistent blockage of the bile ducts, more serious problems may arise. These are the symptoms of complicated gallstone disease, which require immediate medical attention.
- Acute cholecystitis: Due to the blockage, bile accumulates in the gallbladder, leading to inflammation. Symptoms include persistent pain under the right rib cage lasting more than 3 hours, fever, chills and tenderness in the upper right part of the abdomen (Murphy’s sign).
- Bile duct obstruction and jaundice (choledocholithiasis): If a stone from the gallbladder enters the common bile duct and becomes lodged there, it prevents bile from flowing into the small intestine. As a result, a bile pigment called bilirubin builds up in the blood, causing a yellowish discolouration of the skin and the whites of the eyes (jaundice), dark, beer-coloured urine and pale, clay-coloured stools. It may also be accompanied by severe itching.
- Inflammation of the bile ducts (cholangitis): A blockage of the bile duct can lead to a severe bacterial infection, which is accompanied by a high fever, chills, jaundice and abdominal pain. This is a life-threatening condition that requires immediate hospital treatment.
- Pancreatitis (inflammation of the pancreas): If a gallstone becomes lodged at the opening of the pancreatic duct, it can prevent pancreatic juice from reaching the small intestine. The digestive enzymes are activated within the pancreas and begin to „digest” the organ itself. This is an extremely painful and serious condition, characterised by abdominal pain radiating around the waist to the back, accompanied by nausea and vomiting.
Diagnosis of gallstones
If you experience any of the above symptoms, you should definitely consult a doctor. An accurate diagnosis requires consultation with a gastroenterologist. The Endomedix Gastroenterology Centre It provides patients with modern diagnostic equipment to ensure that examinations are as gentle and effective as possible.
- Physical examination and medical history: The doctor will ask about the symptoms and examine the abdomen, checking for tenderness beneath the right costal margin.
- Abdominal ultrasound: This is the primary and most important imaging test for diagnosing gallstones. It is completely painless and detects stones in the gallbladder, as well as any thickening or inflammation of the gallbladder wall, with a high degree of accuracy.
- Laboratory tests: A blood test can help to assess liver and bile function, as well as detect signs of inflammation or elevated bilirubin levels, which may indicate a blockage of the bile duct.
- Endoscopic ultrasound (EUS): In specific cases, where conventional ultrasound does not provide a clear picture, or where gallstones are suspected, this examination may be helpful. Using an ultrasound probe attached to the end of a flexible tube (endoscope), the bile ducts are accessed via the oesophagus and stomach, providing an extremely detailed image.
- ERCP (Endoscopic Retrograde Cholangiopancreatography): This method is both a diagnostic and a therapeutic procedure. It is used when there is a strong suspicion of a stone in the bile duct. A contrast agent is injected into the bile ducts via the endoscope, and an X-ray is then taken. If a stone is found, it can usually be removed during the ERCP procedure.
Treatment options for gallstones
Treatment depends on whether the stone is causing any symptoms.
- Asymptomatic („silent”) gallstones: According to international clinical guidelines, asymptomatic gallstones generally do not require treatment. In such cases, regular medical check-ups and lifestyle changes (see ‘Prevention’) are recommended. Prophylactic (preventative) removal of the gallbladder is only considered in very rare, specific cases.
- Treatment of stomach cramps: In the case of acute biliary colic, pain relief is the primary concern. Non-steroidal anti-inflammatory drugs (NSAIDs, e.g. diclofenac) are the most effective first-line treatment, supplemented with antispasmodics. In cases of severe pain, it may be necessary to administer stronger, even narcotic, painkillers in a hospital setting.
- Definitive treatment of gallstones causing symptoms: If gallstones are causing symptoms, the definitive solution is usually surgical removal of the gallbladder (cholecystectomy). These days, this is most commonly performed using a laparoscopic procedure, which is a minimally invasive technique. The gallbladder is removed through a few small incisions, resulting in a quicker recovery and a shorter hospital stay. The gallbladder is not a vital organ; its removal does not usually cause long-term digestive problems.
- Medical lithotripsy: In the past, medication (ursodeoxycholic acid) was tried, which dissolves cholesterol stones. However, this is a very slow process (it can take months or even years), is only effective for small, pure cholesterol stones, and the stones often recur once treatment is stopped. Nowadays, it is only considered for patients in whom surgery cannot be performed for some reason.
How can gallstones be prevented?
The key to prevention is a healthy lifestyle and minimising risk factors. Although we cannot change our genetics, there is a great deal we can do to prevent gallstones from forming.
1. Maintaining a healthy weight:
This is the most important step. If you are overweight, aim for slow, gradual weight loss (0.5–1 kg per week). Avoid crash diets and starvation diets!
2. A balanced, high-fibre diet:
- Eat plenty of fibre: whole grains, vegetables, fruit, pulses. Fibre aids digestion and reduces cholesterol levels in bile.
- Please select healthy fats: olive oil, avocado, nuts, fish (omega-3 fatty acids). These help to stimulate regular emptying of the gallbladder.
- Avoid the refined carbohydrates and excessive sugar consumption, because these increase the risk of gallstone formation.
- Reduce the saturated fats intake (fatty meats, processed foods).
3. Regular exercise:
At least 2.5 hours of moderate-intensity exercise per week (e.g. brisk walking, cycling, swimming) helps with weight management and improves overall metabolism.
4. Adequate fluid intake:
Make sure you drink enough water throughout the day to help your digestive system function properly.
5. Regular meals:
Don’t skip meals! Fasting or irregular eating slows down bile secretion, which promotes the formation of gallstones. Breakfast is particularly important in this respect.
When should we see a doctor?
It is important not to ignore the symptoms and not to try to treat yourself at home without a diagnosis. Consult a gastroenterologist if:
- She first experiences severe abdominal pain suggestive of biliary colic.
- In addition to cramp-like pain, fever, chills or jaundice may occur.
- The pain is unusually severe, or does not subside even after several hours.
Early diagnosis and appropriate treatment are essential for preventing serious complications.
Summary: What next?
Gallstones are common, but the risk can be reduced through a healthy lifestyle and taking care of one’s health, whilst the condition itself can be treated effectively once it has developed. Prevention is key: maintaining a healthy weight, eating a high-fibre, balanced diet and taking regular exercise. If you experience any symptoms, don’t hesitate to see a doctor! A simple abdominal ultrasound scan can provide a quick and painless answer to your questions.
From Endomedix Gastroenterology Centre Our experienced specialists and state-of-the-art diagnostic facilities ensure that you are in the best possible hands. Don’t let pain or uncertainty rule your life! Take steps to look after your health today.
