Gallbladder disease and gallstones: risks, symptoms and treatment

Gallbladder disease refers to several conditions that affect the gallbladder, a pear-shaped organ that sits under your liver and stores, concentrates and releases bile. 

The most common type of gallbladder disease is gallstones, which affects 10–15% of UK adults. Your risk of gallstones increases with age and is also higher if you’re a woman, have had multiple pregnancies, are overweight or obese, have liver cirrhosis or an inherited blood disorder (eg sickle cell anaemia), or follow a diet high in triglycerides (a type of fat) and refined sugars. 

Gallstones can cause a variety of problems, including: 

• Biliary colic — abdominal pain caused by blockage of the tube through which bile is carried to and from the gallbladder (cystic duct) by a gallstone
• Cholecystitis — inflammation of the gallbladder, often caused by blockage of the cystic duct by a gallstone that leads to pressure building up
• Gangrene and perforation (splitting open) of the gallbladder — these are potentially life-threatening conditions, usually caused by severe cholecystitis

Other types of gallbladder disease include:

• Polyps — non-cancerous growths of the gallbladder; depending on the size of the polyps and other factors affecting the individual, the gallbladder may need to be removed
• Gallbladder cancer — this is relatively rare, with around 1,000 adults in the UK diagnosed each year
• An absent or partially developed gallbladder — some people are born with this condition

Symptoms of gallstones

The most common symptom of gallstones is abdominal pain, which is severe, intermittent and localised to the upper middle or right of your abdomen but can spread to your back and right shoulder. Often pain occurs at night and also is triggered 30–60 minutes after eating a meal, especially if it is fatty. 

If your gallbladder is not inflamed, these painful episodes usually last four to six hours. If your gallbladder is inflamed or infected (cholecystitis), pain can last for several days.

The intensity of your pain can make you feel hot and nauseous and vomit. If you develop cholecystitis, you may present with signs of infection, such as a rapid heart rate, fever, shivers and loss of appetite. 

If your bile duct is blocked by a gallstone, you can also develop jaundice. Symptoms include dark brown urine, itchy skin and yellowing of your skin and whites of your eyes. 

If you experience any of the above symptoms, it’s important to see a doctor. 

Diagnosing gallstones

Your doctor will ask you about your symptoms and medical history and may also conduct a physical examination of your abdomen.

They may then refer you for tests, including blood tests and an ultrasound scan of your abdomen to reveal if gallstones are present. If the results of your ultrasound scan are inconclusive, you my be referred for other tests such as an MRI scan or CT scan. 

Treating gallstones 

Treatment depends on the severity and frequency of your symptoms. 

If your pain is mild and infrequent, your doctor may recommend taking over-the-counter painkillers and prescribe anti-sickness medication. If there is an infection, they will prescribe a course of antibiotics. 

They may also recommend following a low-fat diet to reduce the frequency and severity of your symptoms. 

Surgery

Based upon your symptoms, other health conditions and your preferences, your doctor may recommend surgery to remove your gallbladder. 

This is usually performed as a keyhole surgery where four small cuts are made into your abdomen, through which your gallbladder can be detached from surrounding tissues and removed. In most cases, you can go home on the same day as your surgery or the day after. If you have open surgery, you will need to stay in hospital for three to five days. 

As with every surgery, there are risks of infection, bleeding, clots in the legs or lungs and tissue damage. Specific to gallbladder removal surgery, there is the risk of injuring the bile duct, small gallstones being left behind in the bile duct that may later cause problems, and bile leaking out. 

After surgery, around one in 10 individuals develop diarrhoea that needs to be managed with dietary changes and sometimes medications. 

Alternatives to gallbladder removal

If gallbladder removal surgery is not appropriate due to other health problems, previous major abdominal surgery, or if you prefer not to have surgery, your doctor may recommend a medication that aims to dissolve small gallstones called ursodeoxycholic acid. While some people find this medication helpful, gallstones usually return when the medication is stopped.

If a gallstone moves from your gallbladder and gets stuck in the tube through which bile travels to your small intestine (main bile duct), it may need to be removed using a flexible, telescope-like device inserted through your mouth — this procedure is called an endoscopic retrograde cholangio-pancreatography (ERCP).