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Gallstones

 

Gallstone Introduction

Cholelithiasis is the presence of calculi, or stones, in the gallbladder. Cholelithiasis is commonly referred to as gallstones. The gallstones can be present in the body of the gallbladder or in the bile duct. Gallstones typically consist of cholesterol, but can also consist of bilirubin. Bilirubin gallstones are called pigment stones. For the sake of this article, the term “gallstones” will refer only to cholesterol stones, and not pigment stones. [1] :gallstones.jpg The components of bile are cholesterol, bile acids, phospholipids, electrolytes, and water. Gallstones form when the bile becomes supersaturated with cholesterol. This results from cholesterol levels being too high, or if the levels of bile acids and phospholipids are low in the bile. [2] Slow or inefficient emptying of the gallbladder, or biliary sludge, can also contribute to the formation of gallstones.

Gallstones are usually multiple when diagnosed, though patients can be symptomatic with a single stone. Gallstones are usually less than 2 cm in diameter. [3] They pose a risk to individuals if they cause partial or total obstruction of the bile duct, blocking outflow.

Gallstones affect both men and women, though women are more likely to get them earlier in life. Native Americans and Hispanics are more prone to gallstones than Caucasians. There is an increased risk for developing gallstones with a positive family history. Obesity increases the risk by 3-7 times that of a non-obese person. [4]

Gallstone Symptoms

The signs and symptoms of gallstones can be variable. Many will have stones present for years with no clinical symptoms. The most common presenting sign is pain, occurring when a stone has caused partial or total obstruction of the bile duct. [5]

Pain is usually on the right side and located just under the rib cage. It can radiate to the back, usually in between the scapulae, or shoulder blades. The pain can be described as colic. It is usually constant and progressive until the stone has passed or after the blockage is removed. [6]

Other symptoms that can occur due to gallstones are belching, bloating, fatty food intolerance, nausea, and vomiting. If total blockage occurs the gallbladder can become inflamed and fever and chills will develop. Fever and chills are absent without inflammation. [7]

Gallstone Statistics

It is estimated that 20 million Americans or 10% of the population have gallstones.


  • About 1 million new cases will be diagnosed this year.
  • Each year at least 500,000 people will undergo surgery to remove their gallbladder because of gallstones.
  • There are approximately 800,000 hospitalizations each year due to gallbladder pain.
  • 20% of women and 10% of men will have gallstones after the age of 60. [8]

Gallstone Treatment

Conventional treatment of gallstones is dependant on the size, associated symptoms, and likelihood of developing complications. If individuals are asymptomatic, then no treatment is recommended. If the individual is experiencing symptoms, then surgery is the likely recommendation, especially if complications have the possibility of developing. Laparoscopic cholecystectomy has become a very common and routine medical procedure. If one wishes to avoid surgery, bile acids can be prescribed. Treatment with bile acids has been shown to reduce or dissolve the stones if administered for long periods of time, though side effects are present. Past treatment option, such as shock wave lithotripsy and methyl-tert-butyl ether, are not utilized as often due to the use of laparoscopic surgery.[9]

Alternative treatment if focused on prevention rather than reduction or elimination of gallstones. The focus of treatment is to correct the underlying dysfunction that allowed the formation of gallstones. Because of the serious complications that can occur, any form of treatment should be under the supervision of a physician.

Supplements helpful for Gallstone

Lecithin

Lecithin is also known as phosphatidylcholine. Lecithin is the main phospholipid present in bile. If its levels are low, cholesterol may super concentrate and gallstones can potentially form. Supplementation with lecithin can reduce the chance of gallstones forming. Llecithin will not cause the immediate dissolution or reduction of all ready-formed stones. [10]

Lipotropic factors

Specific lipotropic factors are choline, methionine, carnitine, and Inositol. Lipotropic factors are substances that increase the fat metabolism in the liver. Lipotropic factors work to reduce the amount of fat deposited in the liver, which in turn decrease the amount of cholesterol in the bile (since bile is made in the liver). Lipotropic factors can also affect the amplitude of contraction of the gallbladder, or act as cholegogues. [11]

One particular study found that patients with gallstones have a decreased amplitude of contraction in response to normal signaling from the pancreas. Inositol was shown to improve gallbladder contraction in response to this signal. [12]

Vitamin C

Vitamin C is very useful for the prevention of gallstones. Patients with gallstones have a lower intake of Vitamin C .[13] A deficiency in Vitamin C has been shown to result in a decreased breakdown of cholesterol into bile acids, which results in increased stone formation. [14] Study has shown that high doses of Vitamin C was shown to reduce the tendency of bile to form stones. [15] Another study found that the supplementation of Vitamin C, along with Vitamin E, may provide a far greater reduction in one’s risk of developing gallstones. [16]

Cynara scolymus, Artichoke Leaf

Artichoke leaf is a cholegogue, meaning it stimulates the gallbladder to contract and empty its contents into the small intestine. [17] Because biliary sludge is a contributing factor to the formation of gallstones, cholegogues are an effective treatment. One must be cautious about stimulating the gallbladder. If the gallstones are large enough to get stuck in the bile duct, then stimulation is contraindicated because of the risk of obstruction. In a study using animal models, artichoke leaf extract was also shown to increase both bile acid concentration and bile secretion.[18]

References

[1] Beers M and Berkow R. Cholelithiasis. The Merck Manual 17th Ed. 1999: 400-402.

[2] Pizzorno J, Murray M, Joiner-Bey H. Gallstones. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone New York. Pages: 190-196.

[3] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml The Liver Foundation. November 2004.

[4] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml The Liver Foundation. November 2004.

[5] Beers M and Berkow R. Cholelithiasis. The Merck Manual 17th Ed. 1999: 400-402.

[6] Beers M and Berkow R. Cholelithiasis. The Merck Manual 17th Ed. 1999: 400-402.

[7] Beers M and Berkow R. Cholelithiasis. The Merck Manual 17th Ed. 1999: 400-402.

[8] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml The Liver Foundation. November 2004.

[9] Beers M and Berkow R. Cholelithiasis. The Merck Manual 17th Ed. 1999: 400-402.

[10] Pizzorno J, Murray M, Joiner-Bey H. Gallstones. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone New York. Pages: 190-196.

[11] Pizzorno J, Murray M, Joiner-Bey H. Gallstones. The Clinician’s Handbook of Natural Medicine. 2002 Churchill Livingstone New York. Pages: 190-196.

[12] Behar J et al. Inositol triphosphate restores impaired human gallbladder motility associated with cholesterol stones. Gastroenterology. 1993 Feb; 10(2): 563-568.

[13] Worthington HV et al. A pilot study of anti-oxidant intake in patients with cholesterol gallstones. Nutrition. 1997 Feb; 13(2): 118-127.

[14] Simon JA. Ascorbic acid and cholesterol gallstones. Med Hypotheses. 1993 Feb; 40(2): 81-84.

[15] Gustafsson V et al. The effect of vitamin c in high doses on plasma and biliary lipid composition in patients with cholesterol gallstones and prolongation of nucleation time. Eur J Clin Invest. 1997 May; 27(5): 387-391.

[16] Simon JA, Hudes ES. Serum ascorbic acid and other correlates of gallbladder disease among United States adults. Am J Public Health. 1998 Aug; 88(8): 1208-1212.

[17] Gebhardt R. Anticholestatic activity of flavonoids from artichoke (Cynara scolymus L.) and of their metabolites. Med Sci Monit. 2001 May; 7 Suppl 1: 316-320.

[18] Saenz Rodriguez T et al. Choleretic activity and biliary elimination of lipids and bile acids induced by artichoke leaf extract in rats. Phytomedicine. 2002 Dec; 9(8); 687-693.