Gallstones may be asymptomatic; however, when gallstones block either the cystic or common bile ducts, symptoms occur. Symptoms include dull or crampy abdominal pain that is exacerbated by meals and lasts one to five hours.
Jaundice, nausea and vomiting, rapid heart rate, hypotension (low blood pressure) and fever are other possible symptoms.
What are the risk factors?
There are a multitude of risk factors. Some of these are modifiable, others are not. The modifiable ones include obesity, measured by body mass index (BMI); rapid weight loss; fat consumption; hormone replacement therapy (HRT); oral contraceptives; decreased physical activity; Crohn’s disease and certain drugs.
One non-modifiable risk factor is age; the older we get, the higher the risk, with age 40 being the demarcation line. Other risk factors are gender, with females being more predisposed; pregnancy; and family history.
Obesity may play an important role. The reason is potentially due to bile becoming supersaturated. Bile is produced in the liver and stored in the gallbladder and aids in the breakdown of fats in the small intestines. Crystals may form, creating cholesterol gallstones from the bile.
In a meta-analysis of two prospective, forward-looking observational trials, Copenhagen General Population Study and the Copenhagen City Heart Study, those in the highest quintile of BMI were almost three times as likely to experience symptomatic gallstones compared to those who were in the lowest quintile.
The highest quintile was those who had a mean BMI of 32.5 kg/m2 and thus were obese, whereas those in the lowest quintile had a mean BMI of 20.9 kg/m2. This is a comparison of obese to ideal BMI.
Not surprisingly, since women in general have a higher risk of gallstones, they also have a higher risk when their BMI is in the obese range compared to men, a 3.36-fold increase and 1.51-fold increase, respectively.
Also, the research showed that for every 1 kg/m2 increase in BMI, there was a 7 percent increase in the risk of gallstones. Those who had genetic variants that increased their likelihood of an elevated BMI had an even greater increase in gallstone risk —17 percent — per 1 kg/m2. In the study population of approximately 77,000, more than 4,000 participants became symptomatic for gallstones.
Diabetes rears its ugly head
Just like with obesity, diabetes is almost always a culprit for complications. In a prospective observational study of almost 700 participants, those with diabetes were at a significant 2.55-times greater risk of developing gallstones than those without.
Again, women had a higher propensity than men, but both had significant increases in the risk of gallstone formation, 3.85-times and 2.03-times, respectively. The researchers believe that an alteration in glucose (sugar) metabolism may create this disease risk.
Hormone replacement therapy
If you needed another reason to be leery of hormone replacement therapy (HRT), in a prospective observational trial, women who used HRT, compared to those who did not, had a 10 percent increased risk in cholecystectomy — removal of the gallbladder — to treat gallstones.
Though this may not sound like a large increase, oral HRT increased the risk 16 percent, and oral estrogen-only therapy without progestogens increased risk the most, 38 percent. Transdermal HRT did not have a significantly increased risk.
It is never too early or too late to treat obesity before it causes, in this case, gallstones. With a lack of exercise, obesity is exacerbated and, not surprisingly, so is symptomatic gallstone formation. Diabetes needs to be controlled to prevent complications.
HRT, unless menopausal symptoms are unbearable, continues to show why it may not be a good choice.