Treatment for Gallstones – NIDDK

How do health care professionals treat gallstones?

If your gallstones are not causing symptoms, you probably don’t need treatment. However, if you are having a gallbladder attack or other symptoms, contact your doctor. Although your symptoms may go away, they may appear again and you may need treatment. Your doctor may refer to you a gastroenterologist or surgeon for treatment.

The usual treatment for gallstones is surgery to remove the gallbladder. Doctors sometimes can use nonsurgical treatments to treat cholesterol stones, but pigment stones usually require surgery.

Surgery

Surgery to remove the gallbladder, called cholecystectomy, is one of the most common operations performed on adults in the United States. The gallbladder is not an essential organ, which means you can live normally without a gallbladder.

A health care professional will usually give you general anesthesia for surgery. Once the surgeon removes your gallbladder, bile flows out of your liver through the hepatic duct and common bile duct and directly into the duodenum, instead of being stored in the gallbladder.

Surgeons perform two types of cholecystectomy:

Laparoscopic cholecystectomy. Almost all surgeons perform cholecystectomies with laparoscopy. Surgeons perform many laparoscopic cholecystectomies on an outpatient basis, meaning you may be able to go home the same day. You will probably be able to return to normal physical activity in about a week.

Open cholecystectomy. A surgeon performs an open cholecystectomy when your gallbladder is severely inflamed, infected, or scarred from other operations. Your doctor may perform a cholecystectomy if problems occur during a laparoscopic cholecystectomy. After the surgery, you may need to stay in the hospital for up to a week. You will probably be able to return to normal physical activity after about a month.

Surgery to remove the gallbladder, called cholecystectomy, is one of the most common operations performed on adults in the United States.

What happens after gallbladder removal?

A small number of people have softer and more frequent stools after gallbladder removal, because bile now flows into your duodenum more often. Changes in bowel habits are usually temporary; however, discuss them with your doctor.

All surgeries come with a possible risk of complications; however, gallbladder surgery complications are very rare. The most common complication is injury to the bile ducts, which can cause infection. You may need one or more additional operations to repair the bile ducts.

Nonsurgical treatments

Doctors use nonsurgical treatments for gallstones only in special situations, like if you have cholesterol stones and you have a serious medical condition that prevents surgery. Even with treatment, gallstones can return. Therefore, you may have to be regularly treated for gallstones for a very long time, or even for the rest of your life.

A doctor may use the following types of nonsurgical treatments to remove or break up cholesterol gallstones:

Endoscopic retrograde cholangiopancreatography (ERCP). Sometimes doctors use ERCP to remove a gallstone that is stuck in the common bile duct.

Oral dissolution therapy. Ursodiol (Actigall) and chenodiol (Chenix) are medicines that contain bile acids that can break up gallstones. These medicines work best to break up small cholesterol stones. You may need months or years of treatment to break up all stones.

Shock wave lithotripsy. A doctor can use shock wave lithotripsy to blast gallstones into small pieces. Doctors use this procedure only rarely, and sometimes along with ursodiol.

How can I help prevent gallstones?

You can help prevent gallstones by

• adjusting your eating plan to include more foods high in fiber and healthy fats, fewer refined carbohydrates, and less sugar
• losing weight safely if you are overweight or have obesity
• maintaining a healthy weight through healthy eating and regular physical activity

How to Get Rid of Gallstones Naturally: 9 Treatments to Try

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Doctors typically recommend medication or surgery to treat gallstones. But certain dietary choices may help prevent gallstones from forming.

Gallstones are hard deposits that form in your gallbladder. There are two types of gallstones:

• cholesterol gallstones, which are most common and made up of excess cholesterol
• pigment gallstones, which are made up of excess bilirubin

Surgery is a common treatment for gallstones, but you may be able to treat them with natural remedies. Read on to learn natural remedies for gallstones, plus tips to help prevent this condition.

Gallstones can cause sharp, intense pain in the upper right part of the abdomen. This pain may radiate to your back and up to your shoulder blade. Other symptoms include nausea, vomiting, light-colored or gray stool, and diarrhea.

Talk with your doctor before trying to treat gallstones on your own. Your doctor can help you receive the correct diagnosis. They can also advise you on all of your treatment options. If you have yellowing of the eyes, fever or chills, and intense abdominal pain, seek medical care immediately.

1. Gallbladder cleanse

There are several reasons why gallstones may form:

• Your liver may secrete more bile than it can dissolve.
• Your body may have excess pigment called bilirubin, which cannot be dissolved.
• The gallbladder might not empty completely or as frequently as it needs to.

Some people claim that a gallbladder cleanse or flush can help break up the gallstones and empty the gallbladder. There is no scientific evidence to support these claims, however. The body is able to cleanse and flush itself.

Still, some people consume a combination of olive oil, juice, and herbs for two or more days. During that time, they’re not supposed to consume anything other than the oil mixture. There’s no standard mixture or recipe. This mixture can be dangerous for people with diabetes, or those who experience low blood sugar.

One study looked at the role of olive oil and sunflower oil on gallstones. The researchers found that while olive oil had an effect on bile consumption, it did not affect the gallstones.

Talk to your doctor before beginning any type of cleanse. It may not be safe for all people.

2. Apple juice

Some people use apple juice to treat gallstones. That’s because they believe apple juice may soften gallstones and can help you pass the stones.This claim has spread due to a letter published in 1999, which detailed an anecdotal account of a woman successfully passing her gallstones with the use of apple juice. There are no scientific studies that support this claim, however.

Drinking lots of fruit juice may not be healthy for you if you have diabetes, hypoglycemia, stomach ulcers, and other conditions.

3. Apple cider vinegar

Apple cider vinegar (ACV) is a popular health supplement that’s often included in cleanses. While ACV may have positive effects on blood sugar, there are no studies to support the use of ACV for the treatment of gallstones. There is little evidence that cleanses are needed or effective.

4. Yoga

There are some claims that yoga may help you naturally pass gallstones. Yoga was found in one study to improve lipid profile in people with diabetes. In another study, researchers looked at people with cholesterol gallstones and found that people with these types of gallstones were more likely to have abnormal lipid profiles. The researchers were unable to find a connection between these abnormal levels and the presence of gallstones, however.

While yoga may help relieve some of the symptoms associated with gallstones, there is no scientific evidence to support the use of yoga for the treatment of gallstones.

5. Milk thistle

Milk thistle, or Silybum marianum, may help treat liver and gallbladder disorders. It’s thought to stimulate both organs, but researchers have not specifically looked at the benefits of milk thistle for the treatment of gallstones.

Milk thistle is available in pill form as a supplement. Talk to your doctor before using milk thistle, especially if you have diabetes. Milk thistle may lower blood sugar levels in people with type 2 diabetes. It’s also possible to be allergic to milk thistle.

Shop for milk thistle

6. Artichoke

Artichoke has been found to be beneficial for gallbladder function. It helps stimulate bile and is also beneficial for the liver. No studies have looked at the effect of artichoke on the treatment of gallstones.

Artichoke can be steamed, pickled, or grilled. There is no harm in eating artichoke if you’re able to tolerate it. Artichoke in pill form or sold as a supplement should only be taken after you speak to your doctor.

7. Gold coin grass

Gold coin grass, or Lysimachiae herba, is used in traditional Chinese medicine to treat gallstones. It’s been linked to reduced gallstone formation. Some people recommend taking gold coin grass before beginning a gallstone cleanse to help soften the stones.

You can purchase gold coin grass in powder or liquid form.

8. Castor oil pack

Castor oil packs are another folk remedy, and some people choose to use this method instead of a gallbladder cleanse. Warm cloths are oaked in castor oil, which you then place on your abdomen. The packs are supposed to relieve pain and help treat your gallstones. There are no scientific studies to support claims that this treatment is effective.

Shop for castor oil

9. Acupuncture

Acupuncture may help relieve some of the pain from gallstones by reducing spasms, easing bile flow, and restoring proper function. Acupuncture has been reported to treat gallstones, but more research is needed.

One small study was done to look at the effects of acupuncture on cholecystitis in 60 participants. Cholecystitis is inflammation of the gallbladder. Acupuncture was found to relieve symptoms and reduce the volume of the gallbladder.

More research is needed to specifically look at the benefits of acupuncture for the treatment of gallstones.

Acupuncture is relatively safe. When choosing an acupuncturist, look for a licensed acupuncturist and make sure that they are using new, single-use needles. In some cases, your insurance provider may cover part of the cost. Many cities also have community acupuncture centers. Acupuncture is administered in a room with other people instead of in a private setting. The cost for community acupuncture is often a lot more affordable than private acupuncture.

Medications and surgery are often used to treat gallstones.

Medication

Two bile acids are often prescribed to dissolve smaller gallstones:

• ursodeoxycholic acid
• chenodeoxycholic acid

In an older study from 1989, ursodeoxycholic acid helped prevent gallstone formation in obese people who were following very low-calorie diets.

It may take up to two years for bile acids to treat gallstones. Gallstones may re-form when you stop taking the medication.

Surgery

Surgery is often the recommended treatment for gallstones. Surgery, known as cholecystectomy, involves removing the gallbladder, so gallstones are not able to form again following this treatment.

A gallbladder is not needed for survival, and in most people, the body is able to compensate for the loss of the gallbladder with minimal side effects. Learn more about gallbladder removal surgery.

Gallstones are most common in:

• women
• people 40 years and older
• people with diabetes
• people who are obese
• pregnant women
• people who take hormonal medications
• people who eat high-fat diets

A combination of genetics, diet, and lifestyle factors are likely the cause of gallstones formation.

Diet

A 2006 study reported that women who ate more fruits and vegetables had a lower risk for gallbladder removal surgery than women who ate the least fruits and vegetables. A well-balanced diet that includes a variety of fruits and vegetables may help support a healthy gallbladder and reduce your risk for gallstones. It may also help with weight management.

Some foods may aggravate the gallbladder, including:

• eggs
• refined sugar
• foods with lots of saturated fat
• food allergens

Talk to your doctor about specific foods you may want to avoid.

Weight management

Obesity increases your risk for developing gallstones. Losing weight can be an important part of preventing gallstones, but the way you lose weight matters. Following a very low-calorie diet for weight loss may actually increase your risk for gallstones.

In a 2013 study, participants followed a one-year commercial weight loss program. During the program, one group of participants followed a very low-calorie diet (500 kcal/day) for 6-10 weeks. The other group followed a low-calorie diet (1200-1500 kcal/day) for three months. The group that followed the very low-calorie diet was three times more likely than the other group to develop gallstones that required hospitalization or surgery.

Talk to your doctor about a healthy weight loss program if you are trying to lose weight. They can help you develop a healthy weight loss plan.

There’s little research on the efficacy of natural treatments for gallstones.

Any herbs or supplements sold in the United States are not monitored for quality or purity by the Food and Drug Administration. Research any products carefully, talk to your doctor, and choose from a reputable company. If your doctor has recommended surgery, have an open conversation with them about other options you may be able to try first.

Is it possible to dissolve stones in the gallbladder and how to do it correctly?

There is now a significant increase in interest in the dissolution of gallstones. According to scientific studies, the indications for the treatment of gallstone disease without surgery using the dissolution of stones are rather limited, and there are also a large number of contraindications. To find out the medical view of what are the possibilities for dissolving gallstones, we recommend reading this article.

General information

Gallstone disease (GSD) – a disease accompanied by the formation of stones (calculi) in the gallbladder and biliary tract, with a hereditary predisposition, according to statistics, occurs in 10-15% of the population. It can proceed both asymptomatically and with an abundance of various complaints and complications. In recent years, the number of cases of gallstone disease among younger people has increased, however, this disease is more common in women.

The possibility of dissolution of gallstones is influenced by many factors – their variety and composition, size, location, as well as the absence or presence of exacerbations of cholelithiasis and other factors. Let’s look at everything in order.

Types of stones in the gallbladder and bile ducts

Depending on the composition and method of formation, there are two main types of gallbladder stones – cholesterol and pigment.

Cholesterol stones

Cholesterol stones form predominantly in the gallbladder and consist mainly of cholesterol, the proportion of which usually exceeds 60%. In addition to cholesterol, they may contain protein compounds (mucins), bilirubin compounds with calcium and calcium salts, as well as small amounts of other substances. “Pure” 100% cholesterol stones make up approximately 10-15% of all cholesterol stones. Stones containing less than 60% cholesterol are called mixed.

One of the main reasons for the formation of cholesterol stones is an increased saturation of bile with cholesterol, in addition, the formation of such stones can contribute to a delay in the emptying of the gallbladder.

Pigment stones

Pigment stones account for 10-25% of all gallstones in patients in European countries, but among the population of Asian countries, their incidence is much higher. Like cholesterol, pigment stones are more common in women. They are usually small, fragile, black or dark brown in color and are formed mainly on the basis of bilirubin compounds.

Black pigment stones consist of a black polymer formed from bilirubin and calcium, as well as other compounds of calcium, copper and a large number of complex proteins (mucins). These stones do not contain cholesterol and do not have a distinct crystal structure.

Black pigment stones are more common in patients with liver cirrhosis, in chronic hemolytic conditions (hereditary spherocytic or sickle cell anemia in patients with vascular prostheses, artificial heart valves, etc.). Their formation is facilitated by a supersaturation of bile with indirect, water-insoluble bilirubin and a change in the acidity of bile (pH).

Brown pigment stones consist mainly of calcium salts of indirect bilirubin with the inclusion of varying amounts of cholesterol and proteins.

The formation of brown pigment stones is associated with the presence of infection (cholecystitis, ascending cholangitis), and microscopic examination reveals the structural elements of bacteria in them. Such stones are formed already in the bile ducts under the action of enzymes produced by bacteria.

Pigment stones can form both in the gallbladder and in the ducts, and in the ducts they are detected more often than stones of other composition. In recent decades, there has been a decrease in the frequency of detection of pigment stones, which many researchers attribute to a decrease in the incidence of infectious and inflammatory diseases of the biliary tract.

Which gallstones can be dissolved and with what?

Now let’s look at the situations in which drug dissolution of stones is possible. To dissolve stones, preparations of ursodeoxycholic and chenodosoxyzolic acids are used. Preference is given to the former due to its higher efficiency and lower frequency of side effects.

Can be dissolved :

1. Radiolucent (not distinguishable on radiographs) cholesterol stones with preserved contractile activity of the gallbladder.
2. Radiopositive (lighter on radiographs) stones less than 88 HU on CT scan.
3. Solitary cholesterol stones, no larger than 10 mm.
4. Multiple small cholesterol stones, 5 mm or less, not exceeding 50% of the total gallbladder volume.

What will help you succeed?

Remember that the decision on the possibility of dissolution of stones in the cavity of the gallbladder is made only by a specialist. A gastroenterologist and surgeon can help make an informed decision to assess the possibility of such medical treatment and evaluate all the associated risks.

All attempts at dissolution, which are made without a doctor’s recommendation, may result in the removal of the gallbladder on an emergency basis – along with this, the risks of complications during and after the operation increase.

It is also important to know that the volume of the operation during an emergency operation often expands and may no longer require video laparoscopic intervention from a mini-access, but the traditional removal of the gallbladder using large incisions of the anterior abdominal wall, which is accompanied by significant trauma and more frequent postoperative complications – hernias, infections, etc.

Instrumental examinations for the diagnosis of cholelithiasis

When a doctor decides to prescribe drugs to dissolve stones, it is of great importance to analyze the patient’s complaints, medical history data and the results of examination and instrumental examinations.

The leading position in the diagnosis of cholelithiasis is rightfully occupied by ultrasound using modern ultrasonic devices . The sensitivity and specificity of high-resolution ultrasonography for the detection of gallstones exceed 95%. It is possible to identify stones up to 2 mm in diameter.

In time, ultrasound determines the size of the gallbladder, the degree of thickening of its wall, reveals kinks and constrictions of the bladder, intracavitary structures – stones, polyps, gallstones, etc. It is possible to conduct stress tests to study the functional activity (contractility) of the gallbladder.

Using ultrasound, it is possible to determine the expansion of intra- and extrahepatic ducts, the presence of stones in them (in 50-60% of cases). If an ultrasound scan reveals an expansion of the common bile duct (more than 6-7 mm), the probability of the presence of stones in the common bile duct reaches 75%. It is also important to assess the condition of the pancreas and liver.

It should be noted that the information content of ultrasound is significantly reduced in the presence of a large amount of gas in the intestine and severe obesity.

In order to clarify the density characteristics of stones , to assess the signs of their calcification, if necessary, it is possible to conduct an X-ray survey, computed and magnetic resonance imaging of the abdominal organs.

Other research methods – endoultrasound, magnetic resonance cholangiography are performed strictly according to the indications and doctor’s prescription.

When should gallstones not be dissolved?

1. In case of previous biliary colic.

   How does biliary colic manifest itself?

   These are sudden onset and usually recurring attacks of intense pain. Such attacks can be provoked by the use of sweets, smoked, fried foods or alcohol, physical activity, taking certain medications (antibiotics, NSAIDs).

   Colic is characterized by the following pattern:

   • The attack occurs suddenly, can last for hours, less often – more than 24 hours.
   • Pain is acute, intense, paroxysmal, usually localized in the right hypochondrium, epigastric region, projection of the lower third of the sternum.
   • Pain may radiate to the back, jaw, neck or interscapular space.
   • An attack may be accompanied by:
   • nausea,
   • vomiting without relief
   • infrequently – an increase in body temperature.

   It is important to remember that an attack of pain lasting more than 6 hours may indicate the development of acute cholecystitis and requires a doctor’s consultation to resolve the issue of emergency hospitalization .

2. In the presence of radio-positive (calcified, “dark” on radiographs) stones, with a density of more than 88 HU according to computed tomography.
3. When a non-functioning gallbladder (“disabled”) is detected N.B.! Extremely high risks of complications with the development of obstructive jaundice, peritonitis.
4. When stones occupy more than 30% of the gallbladder cavity.
5. With a long history of the disease. N.B.! Stones that appeared many years ago often contain a large amount of calcium salts, and drugs with a dissolving effect can cause acute surgical complications.
6. Calcified stones.
7. Previous episode of acute cholecystitis treated with medication. N.B! The described gallbladder requires a planned removal.
8. Infectious and inflammatory diseases of the biliary tract.
9. “Injected” stone in the neck of the gallbladder.
10. Fixed, immovable stones – especially in the neck of the gallbladder N. B! High risks of bedsores or pathological anastomosis between the gallbladder and internal organs or the anterior abdominal wall.

Why is it dangerous to use traditional medicine?

The use of traditional medicine to dissolve stones is not recommended, primarily because there is no evidence base for their effectiveness, there are no recommendations on their safety, and possible side effects and contraindications are not described.

In addition, there are cases of complications after the use of traditional medicine, when patients had to be urgently hospitalized in a hospital. For example, situations with toxic hepatitis during treatment with various dietary supplements, when markers of liver damage increased to very high values ​​and were accompanied by jaundice. There have also been cases of blockage of the common bile duct by small stones as a result of an increase in the contractile activity of the gallbladder while taking herbs and nutritional supplements.

Therefore, we recommend dissolving stones only according to indications, under the supervision of a gastroenterologist and drugs with efficacy proven by clinical studies.

If you live in St. Petersburg, you can get a consultation from our center’s gastroenterologists about the presence of indications and the absence of contraindications for drug dissolution of stones.

It is also possible to undergo dissolution of stones under the supervision of a doctor using the comprehensive program “Rescue of the gallbladder with stones” . The program is based on the experience of our specialists, is carried out in several stages and includes all the necessary examinations and doctor’s consultations.

Gallstones and treatments

Gallstones and treatments

Gallstone disease (GSD) is a condition in which gallstones form in the gallbladder due to bile stasis and salt imbalance. Without surgery, gallbladder stones create an obstacle to the flow of bile into the duodenum, and the full breakdown of fats becomes impossible.

Irregular nutrition, starvation, overnutrition, hormonal drugs, low mobility, endocrine imbalance provoke the formation of stones. Dense particles are formed in the bile, which are gradually deposited, compacted and eventually lead to the formation of conglomerates (calculi).

The main components of stones are cholesterol, bilirubin and calcium salts.

The process is gradual. At first, nothing bothers a person. GSD is manifested by biliary colic, when, due to food stress or mechanical displacement, the stone leaves the bladder and clogs the mouth of the bile duct. Bile continues to be produced, the bladder is stretched, the breakdown of food is disturbed. Colic develops – this is an extremely painful condition, which in most cases requires urgent removal of the bladder.

When gallstones formed in the gallbladder – what to do? In this matter, the main thing is not to delay the consultation of a doctor.

Symptoms of gallstones

For a very long time, sometimes decades, gallstones flow without symptoms.

However, the following are warning signs:

• bitterness in the mouth after eating or always present;
• feeling of heaviness on the right under the ribs;
• frequent eructations interspersed with nausea.

The most significant symptom of a gallstone is biliary colic. A sharp pain appears in the right upper abdomen, which gradually increases. The pain radiates to the right arm, collarbone or even to the back. Bitterness in the mouth, excruciating nausea and vomiting joins, but this does not make it any easier. A small stone can reach the duodenum and then pass out with feces.

If this does not happen, obstructive jaundice develops – bile is absorbed into the blood. The bubble becomes inflamed, bedsores or suppuration may form inside. The only way out is to remove stones from the gallbladder.

Causes of stone formation

The exact causes are not fully understood, but doctors are increasingly leaning in favor of the hereditary theory. Both the composition of bile and the structural features of the bile-forming system are important. In the vast majority of cases, patients with gallstone disease are overweight. Risks also increase as animal protein and fat intake increases. Where people eat mainly plant foods and do not overeat, cholelithiasis practically does not occur.

The onset of the disease is the formation of biliary sludge – thick bile. At some point, bilirubin ceases to dissolve completely, and at this stage small stones are formed, which only increase in volume over time. With large calculi, surgery is indispensable.

Types of gallstones and their sizes

There are 4 types of stones:

• cholesterol – formed more often than others;
• pigmented or bilirubin;
• lime or calcium;
• mixed.

Often, different types of stones are found in one person at the same time. Their shape is also different – spherical, needle-shaped, oval, faceted, etc. The sizes of calculi vary widely – from small, similar to sand, to huge weighing up to 80 g, occupying the entire bladder. It is possible to remove stones in the gallbladder with surgical treatment – surgery.

Diagnosis of cholelithiasis

To establish the final diagnosis, several methods are used:

• ultrasonic scanning;
• cholecystoangiography;
• computed tomography;
• nuclear magnetic resonance.

If gallstones are found and there are symptoms, then the optimal treatment is surgery.

Methods of treatment

Treatment for gallstones is surgery. Modern treatment is performed laparoscopically, when endoscopic instruments are inserted into small incisions in the anterior abdominal wall. After such an operation, there are no unaesthetic scars. It is enough to stay in the hospital for 2 or 4 days. The technique of laparoscopic operations for the removal of stones from the gallbladder, used in Best Clinic, has been developed to the smallest detail, so there are practically no complications.

Can a gallstone be cured without surgery? If the characteristics of the disease allow, use lithotripsy (ultrasonic crushing of stones). Stones turn into sand and pass out naturally with feces.

Can gallstones dissolve? There are preparations of bile acids and extracts of medicinal plants that contribute to the destruction of stones. Drug treatment is used for single stones no larger than 2 cm in size.

A common folk remedy for gallstones is lemon juice in a glass of hot water. Apply olive oil, a decoction of red beets, a decoction of dill. However, these folk methods are beneficial only in combination with traditional medicine.

The attending physician will help you choose the best way to treat gallstone disease, taking into account the individual characteristics of the patient’s body.

Prevention of cholelithiasis

Prevention that slows down the formation of gallstones is regular meals in fractional portions 5-6 times a day with a decrease in the amount of refractory fats of animal origin.