Is there a way to dissolve gallstones through nutrition or medication, in order to avoid surgical removal of the gall bladder?
Gallstones are a common problem in this country, and their incidence will probably increase due to the rise in obesity, a risk factor for gallstones. The presence of gallstones — the medical term is cholelithiasis (chole=gallbladder, lithiasis=stones) — is more common in women and grows more common as we age. Pregnancy and a positive family history appear to be the other risk factors.
Why some people form gallstones is not completely understood. In the United States, about 90 percent of gallstones formed contain only cholesterol, or a large percentage of cholesterol. Cholesterol, of course, is a fat and does not dissolve in water. Bile, the liquid formed in the liver and stored in the gallbladder, is largely water. It turns out that bile salts, produced by the liver and useful in the digestion of fats, will solubilize cholesterol; that is, they will coat the cholesterol molecules and allow them to dissolve in a watery medium. One theory about the formation of stones is that they represent an imbalance between the amount of cholesterol and the amount of bile salts in the bile, allowing crystals of cholesterol to form. The medical treatment of gallstones, which I discuss below, attempts to increase the amount of bile salts entering the gallbladder, and thus to improve the solubility of the cholesterol forming the stones. Bile sludge, which is often seen on an ultrasound, is composed of these crystals mixed with mucus and other chemicals, and is probably a precursor of cholelithiasis.
Gallstones cause a type of pain called biliary colic. This is a steady, deep pain in the upper abdomen, often described as stabbing or aching, which may radiate to the upper back or right shoulder. Nausea and vomiting are common with it. It usually reaches a plateau and remains steady for up to 3-4 hours. Pain lasting much longer than that or pain with fever suggests that the gallbladder is inflamed, a condition called cholecystitis.
There are many other symptoms often assumed to be caused by gallstones, such as belching, crampy pain, heartburn, bloating after meals, and intolerance for fatty foods. Although these may indeed be symptoms of gallstones, they are such common symptoms in people who do not have gallstones that their significance is not great. Many people with such vague symptoms undergo surgical removal of the gallbladder (cholecystectomy) only to find that their symptoms continue unchanged. People with true biliary colic from gallstones rarely have their symptoms recur after cholecystectomy.
For many years it was pretty much standard practice to refer anyone with gallstones for cholecystectomy. Now, large long-term follow-up studies of people with gallstones who are asymptomatic, that is, who have never had biliary colic, have shown that such people run a very low risk of serious complications from their condition, so surgery is no longer routinely advised. Even with the modern laparoscopic cholecystectomies, complications occur in about 5 percent, so if the surgery can be avoided without danger, why do it?
You ask if there are medical or nutritional ways to deal with the gallstones without surgery. There is one such treatment — giving ursodiol, a bile salt, orally for 6 to 12 months. Unfortunately, this treatment only works in people with small floating stones whose gallbladders are still functioning normally, that is, expanding and contracting. This limits the people who might benefit from ursodiol to about 15 percent of all people with gallstones. Ursodiol is expensive, and the stones can come back after the treatment course is finished. I know of no nutritional means to dissolve the stones.
Semisurgical methods of getting rid of the stones do exist. One is to pass a catheter through the liver or through the stomach and intestines into the gallbladder and dissolve the stones with an organic solvent. The process takes 24 to 48 hours, and of course the stones can recur. Another is lithotripsy, sound shock waves that fragment the stones, allowing them to pass into the intestine. This can be combined with ursodiol treatment.
You don’t mention if you are having symptoms, or if your gallstones were found by accident during another investigation. If you have been truly asymptomatic, then it may be perfectly acceptable to simply wait and receive follow-up periodically. In studies, only 2.5 percent of a large group of people with silent gallstones developed serious complications over a 10-year period. If you have had several attacks of biliary colic, and certainly if you have had cholecystitis, then the stones and gallbladder should be removed.