Pharma Update

Gallstones are the most common of all gallbladder problems, and can migrate to other parts of the digestive tract and cause life-threatening complications. They are responsible for 90 percent of gallbladder and bile duct disease, and are the fifth most common reason for hospitalization of adults in the United States. Gallstones usually develop in adults between the ages of 20 and 50; about 20 percent of patients with gallstones are over the age of 40. The risk of developing gallstones increases with age — at least 20 percent of people over the age of 60 have a single large stone or as many as several thousand smaller ones. The gender ratio of gallstone patients changes with age. Young women are between two and six times more likely to develop gallstones than men in the same age group. In patients over age 50, the condition affects men and women with equal frequency. Native Americans develop gallstones more often than any other segment of the population; Mexican-Americans have the second-highest incidence of this disease.¹

In many cases, people have ‘silent’ stones, which present no symptoms. Often, gallstones are detected during an abdominal X-ray, computerized axial tomography (CT) scan, or abdominal ultrasound that has been taken for an unrelated problem or complaint. But steady severe pain in the upper abdomen, which may be accompanied by nausea or vomiting, pain between the shoulder blades, or in the right shoulder, are symptoms of a gallstone attack.

When looking for gallstones, the most common diagnostic tool employed is ultrasound, which uses pulses of sound waves sent into the abdomen to create an image of the gallbladder. If stones are present, the sound waves will bounce off the stones, revealing their location. Blood liver tests can also determine whether bile has backed up into the liver.

One-third of all patients with gallstones never experience a subsequent attack. For this reason many doctors advise watchful waiting after the first episode. Reducing the amount of fat in the diet or following a sensible plan of gradual weight loss may be the only treatments required for occasional mild attacks.²

Gallbladder surgery can lead to injury of the bile duct, resulting in leakage of bile or blockage of the duct. Mild cases can be treated without surgery, but more severe cases can require bile duct surgery.

Symptoms of Gallstones

Any of the following can be symptomatic of a gallstone attack. (Similar symptoms can occur in a number of serious diseases, including a heart attack. They also can occur in ordinary indigestion.)

• Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
• Pain in the back between the shoulder blades
• Pain under the right shoulder
• Nausea or vomiting
• Jaundice

The following symptoms of gallstones can present after fatty meals and may occur during the night:

• Abdominal bloating
• Recurring intolerance of fatty foods
• Colic
• Belching
• Gas
• Indigestion

The following symptoms may indicate the presence of gallstones, and should be evaluated by a doctor:

• Sweating
• Chills
• Low-grade fever
• Yellowish color of the skin or whites of the eyes
• Clay-colored stools