Question Title: Gallstones

I am a 26 year old, healthy white female. I am 5'9" and weigh 130 lbs. Over the past year and a half I have suffered tremendous upper abdominal pain, radiating into my back.
The pain would come and go every few weeks, almost always occuring at night. It is so intense and I would lose sleep over it. I went to a clinic, they prescibed Zantac, said it was my stomach, due to stress. Sometimes it seemed to help, but the pain still came and went. It is never a burning pain, just very intense, wrenching pain. My husband finally made me go to a family physician in January. I was tested for H. Pylori, and it came back negative. Next step, ultrasound. Finally, verdict--gallstones--one in particular in the "neck". I have been referred to the surgeon, but have doubts because of my age etc. Do I really need surgery? I have heard horror stories about recurring pain. Don't you need the gallbadder? I have heard about alternative methods, like apple juice, epsom salts, and olive oil, but what about recurrance. I have put up with horrible, terrifying pain and do not want to live like this the rest of my life. Any suggestions? By the way, I have been on birth control pills for about 8 or 9 years (at first for medical reasons, now for birth control) could this cause development of gallstones at my age? Any advice would be appreciated!

Dear Renee,

In patients with biliary pain who have documented gallstones, the current treatment of choice is to surgically remove the gallbladder. This can be performed laparoscopically or with open cholycystectomy. Most surgeons will routinely perform laparoscopic cholecystectomy. In patients who are poor surgical candidates other nonsurgical treatments have been employed. None of these treatments have as good a track record as surgery and recurrence is possible.

Oral bile acid dissolution therapy with ursodeoxycholic acid (Ursodiol, Actigall) can be tried in patients with uncomplicated gallstone disease. The stones must not be calcified and should be less than 10 mm in diameter. The number of stones does not limit treatment with ursodeoxycholic acid as long less than half of the gallbladder volume is occupied by the stones. An oral cholecystogram needs to confirm patency of the cystic duct. With ursodeoxycholic acid, complete dissolution is achieved in 20-70% of patients, but it may take up to 2 years. Recurrence rates are about 50% within five years.

Extracorporeal shock wave lithotripsy (ESWL) can break up large stone fragments or dissolve smaller stones by using sound wave technology to destroy gallstones. Patients may be symptomatic but should have uncomplicated disease. An oral cholecystogram should be performed prior to treatment. The patient should only have one stone which is less than 20 mm in diameter. Sometimes this therapy is used in combination with oral dissolution therapy. In properly selected patients, studies have shown a 64% and 84% stone free interval at 6 months and 12 months respectively. Recurrence rates are 31% at five years.

An approach that has recently been abandoned is direct solvent dissolution therapy. In this method a catheter is placed into the bile ducts where a chemical is infused in order to dissolve gallstones.

A number of reports have shown that the risk of gallstones is 2.0 to 2.5 times higher in women taking oral contraceptive pills. There are several mechanisms felt to contribute to this increased risk. The use of oral contraceptives increases the concentration and total output of cholesterol in bile. Furthermore, bile acids that make bile more soluble are less available. This is because there is less enterohepatic recycling of bile acids and bile is sequestered in the gallbladder and intestine.. The contractility and rate of emptying of the gallbladder are also markedly reduced. Other studies have shown that pregnant women or women taking oral contraceptive agents often require gallbladder surgery. This suggests that estrogen exposure may accelerate the development of symptoms in patients with pre-existing gallstones. The risk of gallbladder disease may also be related to the duration of oral contraceptive use. The increased incidence of gallstones generally occurs during the first 5 years on oral contraceptive pills and decreases in subsequent years. This supports the theory that women who are predisposed to developing gallstones experience a temporary acceleration of cholesterol gallstone formation with oral contraceptive use. The dose and potency of the oral contraceptive may also increase the risk for gallstone formation as well. It would be impossible for you to develop gallstones after your gallbladder is removed. However, sometimes stones can develop in the bile ducts even after cholecystectomy (surgery to remove the gallbladder). Good luck to you. I hope you find this information helpful.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.

HFHSM.D.-ym
*Keywords: oral contraceptive pills, gallstones, laparoscopic cholecystectomy, alternative treatment

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