Thank you for submitting your question. Let me first tell you the risk factors for developing gallstones and see if you can identify and reverse those applicable to you, then discuss treatment options. The common risk factors are:
- Use of estrogen preparations (such as birth control pills)
- Frequent fasting
- Rapid weight loss (including patients who have surgical weight loss treatments)
- Lack of physical activity
- Diabetes mellitus
- Sickle cell disease (and other conditions associated with rapid destruction of red blood cells, such as in patients with mechanical heart valves)
- Cirrhosis, or severe scarring, of the liver
- Certain medications (eg,clofibrate)
There are three general options for people with gallstones; the best option depends upon an individual patient's situation.
- Expectant management: Do nothing, wait and watch.
- Surgical therapy: Removal of the gallbladder and stones. Removing the gallbladder generally has little or no effect on digestion. Loose stools, gas, and bloating may develop in about half of patients who undergo surgery; in most patients these symptoms are mild and do not require treatment.
- Non-surgical therapy:
1. Oral bile acid pill - An oral bile acid pill is a medication that contains a natural bile acid. About two-thirds of patients who take it become symptom free within two to three months after starting treatment, and remain symptom free. However, it may take several years for the stones to disappear completely.
2. Percutaneous electohydraulic lithotripsy - The second non-surgical approach is percutaneous electrohydraulic lithotripsy. In this procedure, a catheter is inserted into the gallbladder under local anesthesia (medicine is injected to numb the skin and prevent pain). The catheter is left in place for two weeks. The patient then returns to have the catheter track stretched until it is the size of a small straw. A small probe is inserted through this track to deliver short bursts of energy, which fractures the stones into small pieces that are then washed out of the gallbladder.
3. Extracorporeal shock wave lithotripsy - The third approach is extracorporeal shock wave lithotripsy (ESWL). Shock waves generated outside the body are focused on the gallstones to fracture them into smaller fragments and "sand," which can then be dissolved more efficiently by an oral bile acid pill. It is most effective in patients with fewer than 3 stones, patients who are normal weight (not obese), and those with good gallbladder function.
Regardless of the treatment you receive, you should also modify your lifestyle to prevent recurrent development of gallstones:
- Eat three well-balanced meals daily, with each meal containing some fat to ensure gallbladder emptying. This prevents collection of bile in the gallbladder, which is one of the risk factors for gallstone formation in susceptible individuals.
- Eat a diet that is high in fiber and calcium and low in saturated fats (fat that is solid at room temperature, eg butter, shortening, lard, meat fat).
- Maintain a normal body weight by eating an appropriate number of calories and exercising for at least 30 minutes five days per week. Obese people (with and without known gallstones) who are planning a rapid weight-loss program should be supervised by a healthcare provider and may require treatment with oral bile acids to prevent gallstone development during weight loss.
I hope this is helpful to you