Answers to 5 common questions about gallstones

Pouring warm maple syrup over freshly cooked waffles is a great way to start the morning. But you may be familiar with the crystallization that can occur with maple syrup. Similarly, hardening, or crystalizing, in digestive fluid deposits can form in the gallbladder causing gallstones.

1. What is the purpose of the gallbladder?

The gallbladder is a small, pear-shaped organ below the liver on the right side of your abdomen. The gallbladder holds digestive fluid, called bile, that's released into the small intestine, and that bile helps your body absorb fats, cholesterol and certain vitamins.

Of the several types of gallstones, the most common is the cholesterol gallstone, which develops due to too much cholesterol combining with bile. Cholesterol stones appear yellow in color.

The second type of gallstone is formed when bile contains too much bilirubin, a chemical produced when the body breaks down red blood cells, creating dark brown or black stones.

Rarer types of gallstones are calcium carbonate and fatty acid calcium stones.

2. Can I have gallstones if I don't have symptoms?

Two-thirds of people with gallstones do not experience any symptoms. Learning gallstones are present may be an incidental finding on an ultrasound performed for another diagnostic reason.

Gallstones that don't cause symptoms typically do not need treatment. Of people with gallstones, 15%‒25% may develop symptoms over the next 10‒15 years.

If gallstones lodge in a duct and cause a blockage, signs and symptoms can occur, and they will last from a few minutes to several hours.

Symptoms can include:

• Upper right quadrant pain in the abdomen
• Pain in the center of your abdomen, below the breastbone
• Back pain between the shoulders
• Pain in the right shoulder
• Nausea
• Vomiting

These symptoms may increase 20‒30 minutes after eating.

3. What causes gallstones?

Many factors lead to the formation of gallstones, including:

• Bile containing too much cholesterol or bilirubin
• Genetics
• Slow small bowel transit
• Bile becoming concentrated due to the gallbladder not emptying completely

4. Are women more likely to develop gallstones?

Gallstones are more likely to develop in certain people. Women are twice as likely as men to experience gallstones.

Other factors may increase your risk of gallstones, including:

• Being over 40
• Being overweight
• Being pregnant
• Having diabetes
• Having a family history of gallstones
• Losing weight rapidly
• Eating a high-fat diet
• Having Crohn's disease
• Having liver cirrhosis

5. If I have a gallbladder attack, will I need surgery?

People who experience symptoms from gallstones in the gallbladder typically require gallbladder removal surgery.

If the gallstones leave the gallbladder and block the bile duct ― a tube that connects the liver, gallbladder and small bowel ― a special endoscopy procedure, called endoscopic retrograde cholangiopancreatography, may be needed to remove the stones.

A right upper quadrant ultrasound can be performed to detect gallstones. An ultrasound detects stones better than a CT scan. An endoscopic ultrasound can detect even small stones in the bile duct and gallbladder. The presence of stones can be a reason to be evaluated by a gastroenterologist or surgeon for treatment. This may include removal of stones from the bile duct, placement of a stent or removal of the gallbladder ― called a cholecystectomy.

Gallstones also can still develop in the bile duct after a cholecystectomy.

You can reduce the risk of gallstones with simple steps:

• Don't skip meals.
  Be consistent with meal times each day. Skipping meals or fasting increases the risk of gallstones.
• Lose weight slowly.
  Aim to lose 1 or 2 pounds a week if you want to lose weight. Rapid weight loss increases the risk of gallstones.
• Eat a high-fiber diet including healthy fats.
  High-fiber foods include a variety of fruits and vegetables. Fish and nuts contain unsaturated, healthy fats.
• Maintain a healthy weight.
  Work to maintain a healthy weight through exercise and good diet.

Talk with your health care provider about occasional or continuous symptoms that may be related to gallstones.

Sebastian Strobel, M.D., specializes in gastroenterology and hepatology in La Crosse, Wisconsin.