Gallbladder Disease and IBD

Crohn's disease is associated with an increased risk of gallstones

Pain from IBD and gallstones

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Gallbladder disease is common in the United States. For people who live with certain types of inflammatory bowel disease (IBD), the risk may be higher.

Gallbladder problems are often caused by gallstones, which are hardened masses of bile and other substances. These stones can block the bile ducts and cause damage, as well as symptoms such as abdominal pain. This article will discuss how gallbladder problems may occur in people with IBD and how they may be treated.

The Gallbladder

The gallbladder is a small organ that's shaped like a pear. It is attached to the liver and it is part of what's called the biliary system. The biliary system includes the gallbladder and its ducts, which go between it and the the liver, the pancreas, and the small intestine.

The function of the gallbladder is to store bile. Bile is a liquid that helps in the digestive process to break down the fats and some of the vitamins in food. Made by the liver and stored in the gallbladder, bile is excreted into the small intestine during digestion.

Bile and and the juices created in the small intestine and the pancreas combine in order to break down food so that it can be absorbed and used by the body.

Gallstones

One problem that can occur in the gallbladder is the formation of hard deposits called gallstones. It's estimated that between 10% and 15% of people in Western countries have gallstones.

Gallstones can occur when there is a problem with how bile is produced and moves through the bile ducts to the liver and the small intestine. Gallstones can be small like a grain of sand or grow as large as an apricot.

Gallstones can block the bile ducts. If that happens, it may cause a gallbladder attack, which is also called biliary colic. The hallmark sign of a gallbladder attack is pain in the upper right abdomen. This pain might happen after a big meal, later in the evening or at night, and last for several hours.

Having one gallbladder attack increases the risk of having more. Having a suspected gallbladder attack is a reason to seek care from a physician in order to determine if there are gallstones present.

A gallbladder attack will need immediate care if any of these signs or symptoms occur:

  • Abdominal pain that lasts several hours
  • Chills
  • Dark urine (tea-colored)
  • Fever
  • Jaundice (eyes or skin becoming yellow)
  • Nausea and vomiting
  • Pale or light-colored stool

Not all gallstones cause symptoms or need treatment. So-called "silent" gallstones may be present but might never cause a gallbladder attack or be found or diagnosed.

A common cause of gallstones is having too much cholesterol in the bile. These are called cholesterol gallstones because they occur when the bile and the cholesterol harden. What results is a stone-like, yellow-green mass that can vary greatly in size. About 80% of gallstones are cholesterol gallstones.

Pigment gallstones are another type of gallstone that is darker in color than cholesterol gallstones. They usually form in conjunction with medical conditions. Some of the conditions that are associated with pigment gallstones are liver disease (such as cirrhosis or infections in the biliary tract) or blood disorders (including sickle cell anemia).

However, the cause of gallstones isn't always known. In some cases, it might not be understood what caused the gallstones.

Gallstones and IBD

Having problems in the biliary system is a common extra-intestinal manifestation of IBD. The risk of gallstones in people with Crohn's disease is double that of what it is for the general population.

It's estimated that the risk of gallstones in the general population is between 5.5% and 15% but for those with Crohn's disease, it is between 11% and 34%. However, after years of debate, for those that have ulcerative colitis, there does not seem to be an increased risk.

There are several factors that have been found to be associated with the risk of gallstones in Crohn's disease. They include:

  • Crohn's disease inflammation in the end of the small intestine and in the large intestine (often called ileocolitis)
  • Having Crohn's disease for more than 15 years
  • Having more than 30 centimeters (cm) of small intestine removed during resection surgery
  • Longer hospital stays
  • Multiple hospital stays (more than three)
  • Being treated with parenteral nutrition several times
  • More than three flare-ups of the disease

In Crohn's disease, rather than gallstones being caused by too much cholesterol, they are more often caused by the malabsorption of bile salts. Active disease in the last part of the small intestine, the terminal ileum, means that bile salts are not being well absorbed there.

Having bile salts not being absorbed properly causes there to be an imbalance in the levels of the juices needed for digestion. This could lead to the development of gallstones.

When people with Crohn's disease have a risk of complications from gallstones, surgery to remove the gallbladder might be needed. However, people with Crohn's disease tend to have a higher risk of post-operative complications after having their gallbladder removed.

Gallbladder Surgery

With the risk of gallbladder stones being increased in risk for people with Crohn's disease, some may wonder about gallbladder surgery (cholecystectomy). When there is a risk of complications with gallstones, it may be decided to remove the gallbladder, as is done for healthy people.

Some may wonder about removing the gallbladder when other surgery, such as a resection, is being done. Removing the gallbladder at the same time as having part of the small intestine, especially the terminal ileum, was done in the past, in some cases.

However, this practice is no longer recommended. While the risk for gallbladder problems is increased for those with Crohn's disease, it's still not high enough to warrant the removal of the organ as a precaution.

Gallbladder surgery may be done as open surgery (with a larger incision) or laparoscopically (with several small incisions). Laparoscopic surgery usually results in shorter hospital stays and quicker recovery.

The decision between open and laparoscopic surgery will be made based on a variety of criteria. This includes the reason for the surgery and if there is any scar tissue present from previous surgeries.

Nonsurgical Treatments for Gallstones

If surgery to remove the gallbladder isn't an option or there's a need to delay it, there are other treatments available. These treatments are not common, however. They include:

  • Contact dissolution therapy: An experimental treatment where a substance that may dissolve gallstones is injected into the gallbladder.
  • Endoscopic retrograde cholangiopancreatogram (ERCP): A flexible tube is inserted down through the mouth and down through the stomach and into the small intestine and the common bile duct. Gallstones that are found within the reach of the instrument may be removed.
  • Percutaneous cholecystostomy: A tube is placed through the abdomen and into the gallbladder to drain gallbladder fluid.

A Word From Verywell

Problems with the gallbladder is more common in people who have Crohn's disease but not ulcerative colitis. The condition may be complicated if there is a flare-up of the IBD. However, treatments are available, including surgery to remove the gallbladder.

Most people don't miss their gallbladder. There is a small percentage of people who experience diarrhea. This is due to the increase of bile that flows into the small intestine after surgery.

For people with Crohn's disease, this is something that's important to discuss with a gastroenterologist and a surgeon. Most people, however, don't notice any change in their digestion after having gallbladder surgery.

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Article Sources
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Additional Reading
  • Chen CH, Lin CL, Kao CH. Association between Inflammatory Bowel Disease and Cholelithiasis: A Nationwide Population-Based Cohort Study. Int J Environ Res Public Health. 2018;15:513. doi:10.3390/ijerph15030513. https://doi.org/10.3390/ijerph15030513