Experts estimate that one in every 12 Americans has gallstones, but most of them don’t even know it. That’s because gallstones—crystalline structures that vary in size from a grain of sand to a golf ball—generally cause no symptoms.
The problems don’t begin, in fact, until a gallstone travels from the pear-shaped gallbladder toward a nearby duct. As the stone passes through or blocks the duct, it triggers a “gallbladder attack.”
Occasionally, gallstones—usually nothing more than a buildup of cholesterol—lead to serious complications, such as inflammation of the gallbladder, pancreas or bile duct.
How can you tell the difference between a gallbladder attack and heartburn? If you feel a sharp, sudden pain in the upper right side of your abdomen (it may even spread to your shoulder blade), chances are good that a gallstone is the culprit—and you should seek medical help.
To confirm the diagnosis, your physician will look for other signs of gallbladder disease, including jaundice, fever and chills. Various blood tests and an ultrasound exam provide further evidence. (By the way, frequent bloating, belching, stomach upset, nausea, diarrhea and constipation are not signs of gallbladder disease.)
Don’t be surprised if your doctor takes a wait-and-see approach, especially if your gallstones were detected by chance (perhaps an ultrasound exam performed to evaluate another condition detected them) or if you’ve just had your first attack. Stones that cause no symptoms may stay that way forever, and if you’ve had a single attack, you run only a one in five risk of having another within the next five years.
When treatment is necessary, however, there are several options, one of which is cholecystectomy—surgical removal of the gallbladder. Not long ago, the procedure meant opening the abdomen, but today the gallbladder is typically removed via laparoscopy, a minimally invasive procedure that requires only several small punctures in the abdomen.
Taken in tablet form, the drugs chenodiol and ursodiol can dissolve small stones made of cholesterol. There are some drawbacks, however: They may take up to two years to work, and it’s not a permanent solution. In fact, half of those treated with drugs can expect a recurrence of gallstone symptoms within five years. Currently under investigation is methyl tertbutyl ether, a powerful solvent that is injected directly into the gallbladder.
Yet another alternative is lithotripsy, a technique that uses shock waves to break the stones into tiny fragments that easily pass through the body. Lithotripsy is generally used in combination with medication.