Pain in the upper right side or middle of the abdomen can indicate various health problems, but one of them is the presence of gallstones. The pain is often described as a sudden, intense, and cramp-like sensation, which may come and go, lasting from several minutes to a few hours. If you suspect gallstones, it is advisable to seek medical attention and to confirm whether a surgical procedure is needed at all. Speaking with the OnlyMyHealth team, Dr Kavya Dendukuri, Senior Gastroenterologist, Kamineni Hospitals, Hyderabad, discusses whether gallstones can be removed without surgery and the kind of non-surgical treatment options available.
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How Are Gallstones Formed?
“Gallbladder stones, also known as gallstones, are solid deposits that form in the gallbladder,” said Dr Dendukuri, adding, “They can range in size from a grain of sand to a golf ball and are primarily composed of cholesterol or bilirubin.”
Gallstones are formed when there is an imbalance in the substances that make up bile, a fluid produced by the liver and stored in the gallbladder. Bile contains cholesterol, bilirubin - a pigment derived from the breakdown of red blood cells - bile salts, and other compounds.
According to a study published in the World Journal of Emergency Surgery, 10–15% of the adult population is affected in developed countries.
Can Gallbladder Stones Be Removed Without Surgery?
While surgery is commonly recommended for the removal of gallbladder stones depending on the size of the stone (>5 mm), there may be non-surgical treatment options (for stones <5 mm) available, as per Dr Dendukuri.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), nonsurgical treatments for gallstones may be recommended only in special situations, like if you have cholesterol stones and you have a serious medical condition that prevents surgery. However, even with treatment, gallstones can return, which is why one may have to be regularly treated for gallstones for a very long time, or even for the rest of your life.
Dr Dendukuri said, “In most cases, gallbladder stones do not resolve on their own and often require surgical intervention. However, certain factors may influence the potential for non-surgical resolution. Gallstones composed mainly of cholesterol are more likely to respond to non-surgical treatments, while those containing calcium or bilirubin are less likely to dissolve without surgical intervention.”
It is essential to consult with a gastroenterologist or a hepatologist, to determine the most appropriate course of action based on individual circumstances.
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Non-Surgical Treatment Options For Gallbladder Stones
Here are some non-surgical treatment options for gallstones:
Medications
Certain medications may be prescribed to dissolve gallstones, especially those primarily composed of cholesterol. Ursodeoxycholic Acid (UDCA) is commonly used to break down cholesterol-based gallstones over time. However, this method is often more effective for small stones and may take months or even years to achieve complete dissolution.
Oral Dissolution Therapy
Oral dissolution therapy involves taking medications that help dissolve gallstones. This treatment is most effective for small stones and requires strict adherence to the prescribed regimen. It is generally not recommended for large stones or for individuals with certain medical conditions.
Extracorporeal Shock Wave Lithotripsy (ESWL)
ESWL is a non-invasive procedure that uses shock waves to break down gallstones into smaller pieces. Once the stones are fragmented, they can pass through the bile ducts more easily. ESWL is usually recommended for patients with small or medium-sized gallstones and is not suitable for everyone. It is typically performed under sedation or general anaesthesia.
Early Signs Of Gallstones To Watch Out For
As per Dr Dendukuri, recognising the early signs of gallstones is important for timely treatment. These include:
- Intermittent or persistent pain in the upper right or middle abdomen, which can vary in intensity and may radiate to the back or right shoulder
- Digestive disturbances, leading to nausea and vomiting; can occur after consuming fatty or greasy foods
- Jaundice, which is characterised by yellowing of the skin and eyes, dark urine, and pale stools; occurs when a gallstone blocks the bile duct
- Bloating, gas, and indigestion after meals; occurs when gallstones interfere with the normal flow of bile
Conclusion
Irrespective of whether you need surgery or not, it is important to address any suspicion regarding gallstones. Untreated gallstones can lead to complications such as biliary colic or severe pain, cholecystitis, which is the inflammation of the gallbladder, choledocholithiasis, an obstruction of the bile ducts, and pancreatitis, which is the inflammation of the pancreas. Contact your healthcare provider immediately.