How Gallbladder Disease Is Treated

The treatment of gallbladder disease depends on the type of disease present. When it comes to treating gallstones, there are generally three options—a "watch and wait" approach if there are no symptoms, surgery to remove the gallbladder and the stones, or medication to break up the gallstones. Treating other gallbladder or bile duct problems, such as a stone that is lodged in the common bile duct, may require a more specialized procedure called an ERCP.

The most common manifestation of gallbladder disease is gallstones. Most gallstones, though, cause no symptoms and therefore do not warrant treatment.

When they do cause pain, though, surgery is generally warranted. Medications are rarely used to treat gallstones, although they are used to treat the pain of gallbladder disease.

When treating gallbladder disease, your doctor will want to treat both your symptoms and the underlying diagnosis.

Treating Symptoms

The most common symptom of gallbladder disease is pain, usually in the upper right side of the abdomen. Your doctor may treat your pain with a nonsteroidal anti-inflammatory (NSAID) like ibuprofen, or an opioid like morphine.

It's important to note that opioids often make people sleepy and commonly cause constipation, which is why your doctor may recommend taking a laxative along with your pain pill.

Treating Underlying Gallbladder Problem

A bile acid pill such as Actigall (ursodiol) can be taken to break down cholesterol gallstones, which are the most common type of gallstone in the United States. While this pill is generally well-tolerated, some people develop mild diarrhea, although it usually goes away with time.

A downside of taking a bile acid pill is that it can take many years for the gallstones to fully dissolve; so a bile acid pill is not a good option for people with recurrent gallstone attacks.

If a person has evidence of infection of the gallbladder or of the biliary tract (a complication of gallstones) he or she will require antibiotics (given in the hospital), along with fluids and pain control, until definitive treatment like surgery or an ERCP (see below) is done.

The primary treatment for the vast majority of gallbladder diseases is surgical removal of the gallbladder, called a cholecystectomy.

However, there are non-surgical options, mostly for people who are too high risk to undergo surgery. The downside of non-surgical options is that the gallbladder is still present, so gallbladder disease (mainly gallstones) may recur.

Cholecystectomy

A cholecystectomy is performed under general anesthesia in an operating room and is the most effective treatment for gallbladder disease.

In the vast majority of people, this surgery is done laparoscopically, which entails the surgeon inserting a thin, flexible instrument (with a video camera at the end) through a small cut in the abdomen. Using long instruments, the surgeon will make multiple small puncture holes in the abdomen, and remove the gallbladder.

A laparoscopic cholecystectomy is less invasive and generally easier to recover from than an open cholecystectomy, in which a large abdominal cut is made to remove the gallbladder.

Gallbladder Cancer

A laparoscopic cholecystectomy is not generally used to treat gallbladder cancer because there is a risk that some of the cancer will be missed. Moreover, there is a concern for "seeding" or spreading the cancer to other parts of the body. Instead, for treating gallbladder cancer, a surgeon will perform an extended cholecystectomy, also called a radial cholecystectomy.

During an extended cholecystectomy, a surgeon will remove the gallbladder, some of the liver tissue near the gallbladder, and any nearby lymph nodes. Sometimes, more tissues are removed (for example, the common bile duct, pancreas, or a large part of the liver), depending on how far the cancer has spread. Radiation and chemotherapy may also be used to treat gallbladder cancer.

Surgical Risks

As with any surgery, there are risks involved, which may include:

• Bleeding
• Incision site infection
• Blood clots
• Pneumonia
• Complications from anesthesia

Your doctor will monitor you to make sure these effects are addressed promptly and appropriately.

Surgical Side Effects

Even though it's safe and OK to live without a gallbladder, some people experience gas, bloating, and diarrhea after gallbladder removal. While this is generally temporary, it may persist for years in some people.

There may be more serious side effects from an extended cholecystectomy for gallbladder cancer, like digestive or eating problems, bile spillage into the abdomen, or liver failure. Rest assured that your doctor will monitor and address these risks.

Percutaneous Removal

If a person needs to have their gallbladder removed but has multiple medical conditions, so is considered a high risk for surgery, he may undergo a series of drainage procedures to clear the obstructing stone(s).

With percutaneous stone removal, a very thin tube called a catheter is inserted through the skin and into the gallbladder to allow for bile drainage. The bile drains through a drainage bulb connected to the end of the catheter. Then, over the next few weeks, the hole through which the catheter was placed is gradually enlarged, allowing for the stone(s) to be removed.

Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is a non-surgical procedure that is rarely used to treat gallstones. This procedure is performed under sedation and entails using shock waves to break up gallstones into tiny pieces, which can then dissolve and drain out of the gallbladder.

If used, ESWL is reserved for people who are not obese, have fewer than three gallstones, and who have a healthily functioning gallbladder.

A procedure called an endoscopic retrograde cholangiopancreatography (ERCP) allows a doctor to visualize the bile ducts for any abnormalities like an obstructing gallstone, cyst, or tumor. While diagnostic, an ERCP is also therapeutic, as a doctor can treat the condition at the same time. For the most part, ERCP has replaced surgery for the treatment of bile ducts problems in patients.

An ERCP is a procedure done to relieve an obstruction of a bile duct, most commonly from a stone.

What to Expect

During an ERCP, a gastroenterologist will guide a thin, flexible tube that has a tiny camera on the end of it (called an endoscope) down the mouth into the stomach and small intestine. A contrast dye is then injected through the tube to visualize the bile ducts on x-ray. If an obstruction is seen, the gastroenterologist may use special instruments (inserted through the endoscope to remove or ease the blockage). For instance, the doctor may remove a stone that is obstructing the common bile duct or place a stent if the duct is narrowed.

A person is sedated during an ERCP to prevent any discomfort and to ensure they are relaxed. While an ERCP is generally a safe and well-tolerated procedure, a person may experience a mild sore throat or bloating after the procedure.

Uncommonly, ERCP-related complications may occur, including:

• Pancreatitis, which is usually mild, but will require a short hospital stay for fluids and pain management
• A hole in the intestine (called a perforation), which is rare and serious, and requires surgery to fix
• Infection of the bile ducts (called cholangitis), which requires a hospital stay for antibiotics and drainage of excess fluid
• Aspiration pneumonia, which is why it's important to not eat or drink for several hours before the procedure

While gallbladder disease must be treated by a doctor, it's sensible to consider complementary therapies. That said, it's important to only take any herbs, vitamins, or dietary supplements under the guidance of your personal doctor.

Herbs

Certain herbs like silymarin (Silybum marianum), also called milk thistle, may provide both gallbladder and liver support. Other research suggests that herbs like turmeric, Oregon grape, bupleurum, and coin grass may ease gallbladder inflammation and relieve liver congestion.

Natural Foods

Adopting a gallbladder friendly diet may help prevent further gallbladder attacks. A gallbladder-friendly diet is one that is rich in fruits and vegetables, especially vegetables high in vitamin B and iron, like spinach and kale, and antioxidant-rich foods like blueberries, cherries, tomatoes, squash, and bell peppers. Healthier proteins like lean meats, fish, tofu, or beans and whole grains are preferable.

Acupuncture

One small Chinese study found that acupuncture eased symptoms of gallbladder inflammation (called cholecystitis), like shoulder-back pain and stomachache. While acupuncture may relieve the pain of gallbladder disease, it's important to see a doctor for treatment (surgery, most likely) of the underlying problem.

A sedentary lifestyle and health conditions like diabetes, obesity, and metabolic syndrome are associated with gallbladder disease, particularly the formation of gallstones.

The good news is that a person may lower their risk for developing gallstones (and related complications) by maintaining a normal body mass index (BMI), exercising daily, and seeing their primary care doctor for regular control over their diabetes or high cholesterol (if present).

As an aside, if you are overweight or obese and embarking on a weight loss regimen, be sure to do it under the guidance of your doctor, as rapid weight loss increases your risk of gallstone formation.

Lastly, when choosing a diet, research has found that a healthy dietary pattern that includes a high intake of vegetables, fruits, low-fat dairy products, whole grains, legumes, and spices is linked to a lower risk of gallstone disease. Interestingly, research also shows that alcohol consumption may reduce a person's risk for developing gallstones.