Gallstones

Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases, gallstones do not cause any symptoms.

However, in a minority of cases, the gallstones can become trapped in a duct (an opening or channel), irritate and inflame the gallbladder, or move out of the gall bladder and into other parts of the body. This can lead to a range of symptoms such as:

• a sudden intense pain in your abdomen,
• nausea and vomiting, and
• jaundice - yellowing of the skin and the whites of the eyes.

‘Gallstone disease’ is the general term that is used to describe the symptoms and associated complications that are caused by gallstones.

The gallbladder

The gallbladder is a small, pear-shaped, pouch-like organ that is situated underneath the liver. The main purpose of the gall bladder is to store and concentrate bile.

Bile is a liquid that is produced by the liver and is used to help with the digestion of fats. It is passed from the liver through a series of channels, known as bile ducts, into the gallbladder.

The bile is stored in the gallbladder and, over time, it becomes more concentrated (stronger), increasing its effectiveness at digesting fats. The gallbladder is able to release bile into the digestive system as and when it is required.

While the gallbladder is a useful organ, it is not an essential one. You can safely have your gallbladder removed without it interfering with your ability to digest food.

Types of gallstones disease

There are three main types of gallstone disease, which are outlined below.

• Asymptomatic gallstones - are when gallstones are present in the gallbladder, but do not cause any symptoms.
• Uncomplicated gallstone disease - is usually caused when gallstones block the opening to the bile duct. This usually leads to repeated episodes of abdominal pain that last between 1-5 hours. The episodes of pain usually occur infrequently; it may be several weeks, or even months, before you experience a further episode.
• Complicated gallstone disease - is when gallstones have triggered a range of more serious complications, such as inflammation of the gall bladder (cholecystitis). Symptoms of complicated gallstone disease tend to be wide-ranging and severe, and can include a high temperature (fever) of 38C (100.4F) or above, jaundice, and constant abdominal pain.

How common are gallstones?

Gallstones are very common. For example, it is estimated that, in England, between 10-15% of the adult population have gallstones which, in most cases, are asymptomatic (do not cause symptoms).

Every year, it is estimated that 1-4% of people with asymptomatic gallstones will go on to develop uncomplicated and/or complicated gallstone disease. Most people usually experience the symptoms of uncomplicated gallstone disease before going on to develop complications. However, not everyone with uncomplicated gallstones disease will also have complications.

Known risk factors for gallstones include:

• age - the older a person is, the more likely they are to develop gallstones,
• sex - women are 2-3 times more likely to develop gallstones than men, and
• obesity.

Outlook

The outlook for gallstone disease is good. Both uncomplicated and complicated gallstone disease can be treated by surgically removing the gallbladder, which is a relatively straightforward procedure with a good success rate. However, not everyone with uncomplicated gallstone disease will require surgery if their symptoms are not particularly frequent or severe.

Even though gallstones disease can usually be easily and successfully treated, it is important not to be overly complacent because some of the complications of the condition can be life threatening. For example, in England and Wales during 2008, there were 650 deaths as a result of gallstone disease, with the majority of deaths occurring in people aged over 70 years of age.

As a result of the risks that are associated with complicated gallstone disease, the condition may require immediately treatment. See the 'symptoms' section for more information.