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How Do I Know If I Have Them?

If your symptoms suggest a gallstone-obstructed duct, your doctor might first examine your skin for jaundice, then feel your abdomen to check for tenderness. A blood test may reveal evidence of an obstruction.

Because other digestive problems, such as an infection of the duct, can produce symptoms similar to those of a gallstone attack, the doctor may also run other tests to determine if gallstones are in fact the culprit. The most common technique is an ultrasound examination. This quick, painless procedure uses high-frequency sound waves to create pictures of the gallbladder, bile duct, and their contents. CT scans are also sometimes done to look at the anatomy of your internal organs.

A more complicated test may be used if the doctor suspects that a gallstone is lodged in the bile duct. Commonly known by the acronym ERCP, this test allows the physician to look at the bile duct through a small flexible tube called an endoscope. The doctor sprays the back of the patient's throat with an anesthetic drug to prevent gagging, then passes the endoscope into the mouth, through the stomach, and into the area of the small intestine where the bile duct enters. Dye is injected through the tube and into the bile duct, then X-rays are taken. The procedure takes about an hour.

What Are the Treatments?

In most cases, treatment of gallstones is considered necessary only if they are symptomatic. Of the various conventional treatments that are available, surgical removal of the gallbladder is the most widely used. Some alternative treatments have also been found to be effective in alleviating the symptoms of troublesome gallstones.

Conventional Medicine

When deciding what course of action to take for symptomatic gallstones, doctors usually choose from among three main treatment options: Watchful waiting, nonsurgical therapy, and surgical removal of the gallbladder.

Watchful Waiting.

Though a gallstone episode can be extremely painful or frightening, almost a third to half of all people who experience an attack never have a recurrence. In some cases, the stone dissolves or becomes dislodged and thereby resumes its "silence." Because the problem may solve itself without intervention, many doctors take a wait-and-see approach following the initial episode.

Even when the patient has had repeated gallstone episodes, the physician may postpone treatment or surgery because of other health concerns. If your surgery has been delayed, you should remain under a doctor's care and report any recurrences of gallstone symptoms immediately.

Nonsurgical Therapy.

If you are unable or unwilling to go through surgery for a gallstone problem that requires treatment, your physician may recommend one of several noninvasive techniques. Note that though these methods may destroy symptom-causing gallstones, they can do nothing to prevent others from forming and recurrence is common.

Some gallstones can be dissolved through the use of a bile salt, although the procedure can be used only with stones formed from cholesterol and not from bile pigments. The drug ursodiol (Actigall) is taken as a tablet and the salt dissolves the stone by increasing the level of bile acids in the gallbladder. Depending on its size, the gallstone may take months or even years to go away and often people need to take this medication indefinitely.

Another nonsurgical technique, shock wave therapy, uses high-frequency sound waves to fragment the stones. Bile salt is administered afterward to dissolve the small pieces.

A method called contact dissolution can also be used to dissolve gallstones. The doctor inserts a catheter through the abdomen, then injects a special drug directly into the gallbladder. In many cases, the stone disappears within a few hours. Contact dissolution and shock wave therapy are still considered experimental.

Doctors can also attempt to remove gallstones during an ERCP. During the procedure a cutting instrument is inserted through the endoscope to attempt removal of the stone.

Surgical Removal of the Gallbladder.

While the gallbladder serves an important function, it is not essential for a normal, healthy life. When gallstones are persistently troublesome, doctors often recommend removing the organ entirely. This operation is considered among the safest of all surgical procedures. Each year approximately 500,000 Americans have their gallbladder removed. It is also the only treatment method that eliminates the possibility that other gallstones will develop in the future.

When the gallbladder has been removed, bile flows directly from the liver into the small intestine, and this sometimes leads to digestion problems. Because bile no longer accumulates in the gallbladder, quantities of the digestive fluid cannot be stored up and used to break down an especially fatty meal. This condition is not considered serious, however, and can be corrected by simply limiting fat in the diet.

Until recently, removal of the gallbladder was done through traditional "open" surgery, which requires surgeons to make a large incision in the abdomen. Patients faced a two- or three-day hospital stay plus several weeks of recovery at home.

Today, however, the most commonly used surgical technique is a much simpler approach known as laparoscopic cholecystectomy. The doctor makes several small incisions in the abdomen, then uses special pencil-thin instruments to remove the gallbladder. A tiny microscope and video camera, snaked through the incision to the site, allow the physician to view the operation.

Laparoscopic surgery is highly effective and very safe. It has reduced the hospital stay to a day or two. Patients report less pain and are generally able to resume a normal lifestyle in a short period of time. However, people who are obese or who have a severe infection or inflammation in the gallbladder may still be considered candidates for traditional open surgery.

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