FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S GALLBLADDER PROBABLY NEEDS SURGICAL REMOVAL

Question: I have recently been diagnosed with attacks of gallstones. Since there are no other problems with my gallbladder, I would prefer trying to dissolve the stones rather than having surgery. One treatment would break the stones up with sound waves or laser, and the other is using a vinegar and honey drink. Can you give me any more details regarding these two possible treatments?

Answer: The gallbladder is an important but not essential part of our digestive system. It is a muscular, sack-like structure that is attached to the liver and collects a substance called bile that the liver produces. The liver produces bile rather slowly, but when needed during digestion of certain foods, the gallbladder rapidly squirts bile juices into the digestive tract. These juices enter the digestive tract at a point just "downstream" from the stomach in an area called the duodenum.

Bile is made from cholesterol, certain fat-like substances, pigments that are the residue of recycled blood cells, and other components. These chemicals aid in the emulsification, digestion, and absorption of foods, particularly fats. The liver is capable

of excreting these products into the gallbladder in a concentration so strong that crystals precipitate out of the solution. These crystals are what form gallstones. This gallstone formation process is similar to growing sugar crystal candy, for those of you who have done this with your children.

Gallstones are very common. Somewhere between 10 and 18 percent of US citizens have gallstones by the time of death, but only 2 percent ever have symptoms. The typical symptoms are discomfort in the upper abdomen or chest. This pain can be quite acute, or it may less severe, and it usually strikes 30 to 90 minutes after a meal. The pain may radiate to the area of the back between the shoulders. Belching, flatulence and bloating often accompany gallbladder attacks, and these symptoms may be present without episodes of pain.

There are several treatments for gallstones. One option is to do nothing at all. About 30 percent of individuals who have stones and have had one attack will have no subsequent episodes. Those who have had several attacks, however, are at great risk for future episodes, including very serious ones that require emergency surgery. Since you used the plural "attacks" to describe your problem, I'd assume that you fall into the "something needs to be done" group.

Dissolving gallstones sounds like a great idea. Unfortunately, it only works in about 15 percent of those with stones, and it requires taking a medication named ursodiol for six to 12 months. Honey and vinegar will do nothing to dissolve the stones. Don't waste your time trying it.

Gallstones can be crushed to make them smaller and easier to pass by the special application of sound waves or lasers. These treatments are not pain free, are expensive, and work best if additional treatment with ursodiol is used to help dissolve the fragments. The risks and potential complications with these treatments are about the same as those from laparoscopic removal of the gallbladder. If it were my gallbladder with stones, I'd have it surgically removed. I'd suggest that you talk with your surgeon and a specialist in digestive diseases, a gastroenterologist, before you make up your mind.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.