Gallbladder stones, also known as gallstones, are a common medical condition worldwide, including in Northeast India. Gallstones are hardened deposits that form in the gallbladder, a small organ located beneath the liver. They can vary in size and composition, ranging from small sand-like particles to larger stones.
The prevalence of gallbladder stones can vary among different populations and regions. The incidence of gallbladder stones and gallbladder cancer is higher in the north eastern part of India compared to the rest of India.
A mnemonic for remembering risk factors for cholesterol gallstones is the 5 F’s: Fat (overweight), Forty (age near or above 40), female, fertile (premenopausal- increased estrogen is thought to increase cholesterol levels in bile and decrease gallbladder contractions), and fair (gallstones more common in Caucasians).
Several factors contribute to the development of gallstones, including genetics, diet, obesity, and hormonal changes. The high consumption of a fatty, cholesterol-rich diet is often associated with an increased risk of gallstone formation. Additionally, certain medical conditions and medications can also predispose individuals to develop gallstones.
The symptoms of gallstones can vary from person to person. Some individuals may experience no symptoms at all, while others may develop symptoms such as abdominal pain, nausea, vomiting, bloating, and jaundice if the stones block the bile ducts.
Gallstones are associated with various complications, including gallbladder cancer, although the risk is relatively low. Gallbladder cancer is a relatively rare form of cancer, and its incidence can vary depending on several factors, including geographical location, genetic predisposition, and lifestyle factors.
In general, regions with a higher prevalence of gallstones tend to have a higher incidence of gallbladder cancer. Unfortunately, Northeast India is known to have a higher incidence of both gallstones and gallbladder cancer compared to other parts of the country.
Gallbladder cancer often develops in individuals who have had long-standing gallstone disease. The exact relationship between gallstones and gallbladder cancer is not fully understood, but it is believed that chronic inflammation caused by gallstones may contribute to the development of cancerous cells over time.
Other complications associated with gallstones include:
Cholecystitis: Gallstones can cause inflammation of the gallbladder, leading to symptoms such as abdominal pain, fever, and nausea. This condition, known as cholecystitis, often requires surgical removal of the gallbladder.
Choledocholithiasis: If gallstones move from the gallbladder and block the common bile duct, it can result in choledocholithiasis. This condition can cause symptoms like jaundice, abdominal pain, and infection.
Pancreatitis: Sometimes, gallstones can migrate and block the pancreatic duct, leading to pancreatitis, which is inflammation of the pancreas. Pancreatitis can cause severe abdominal pain, nausea, and vomiting.
Biliary colic: This refers to sudden and intense pain caused by a gallstone temporarily blocking the bile duct. The pain typically subsides when the stone moves or passes.
Treatment options for gallstones include:
Watchful waiting: If the gallstones are not causing any symptoms, doctors may choose to monitor the condition without immediate intervention.
Medications: In some cases, medications can be prescribed to dissolve certain types of gallstones. However, this approach is typically reserved for small cholesterol stones and can take months or even years to be effective.
ERCP: Its an endoscopic procedure which is used to remove stones which are stuck in the common bile duct.
This is a procedure which should be done in patients with choledocholithiasis and biliary pancreatitis.
Surgery: The most common and effective treatment for gallstones is surgical removal of the gallbladder, known as cholecystectomy. This procedure can be performed through open surgery or minimally invasive laparoscopic techniques. Robotic assisted gallbladder removal is being done in higher centers now.
If you suspect you have gallstones or are experiencing symptoms, it’s important to consult a healthcare professional. They will be able to assess your condition, perform any necessary tests, and recommend an appropriate course of action based on your specific situation.
(Dr Rao is a Senior Consultant Gastroenterologist, Hepatologist & Advanced Therapeutic Endoscopist, Yashoda Hospitals Hyderabad)