Gallbladder disease

Gallbladder disease is swelling of the gallbladder. This pear-shaped organ under the liver stores bile, fluid that helps with digestion. Gallbladder disease often occurs with gallstones. You can have gallstones without any symptoms. However, if the stones are large, they can block the duct that leads from the gallbladder. This can cause pain and require treatment. At first they may block the duct and move away, causing only occasional pain. Continuous blockage of the duct, however, can be life-threatening and requires surgical removal of the gallbladder.

Signs and Symptoms

• Pain, mostly on the upper right side of the abdomen
• Pain following meals, intolerance of fatty foods
• Nausea, vomiting
• Loss of appetite

What Causes It?

Inflammation causes a gallbladder attack. This usually happens because a stone is blocking a passageway in the gallbladder. Gallstones develop in the gallbladder when substances in bile form hard particles. They can be as small as a grain of sand or as large as a golf ball.

What to Expect at Your Provider's Office

If you are having a gallbladder attack, you will feel tenderness when the upper right side of your abdomen is touched. Jaundice (yellowing of the skin) occurs when the bile duct (a tube between the liver and gallbladder) is also blocked. If your health care provider thinks you have a gallstone, you will probably need an ultrasound. During an ultrasound, sound waves take pictures of your gallbladder. This test is painless and can be performed quickly, which is important if you are in a lot of pain.

Treatment Options

Gallbladders that cause pain are usually removed. There are no known problems caused by living without a gallbladder. Doctors use a laparoscope to perform most gallbladder surgery today. This instrument shows the surgeon pictures of your gallbladder as it is being removed. The minimally invasive procedure allows for a smaller incision and a shorter hospital stay than traditional surgery.

Some drugs can dissolve stones, avoiding the need for surgery. However, it can take 2 years for a stone to dissolve, and gallstones often recur later.

• An oral bile acid, ursodeoxycholic acid (ursodiol), can dissolve cholesterol stones that are quite small (less than 15 mm in diameter). The drugs is successful in about 40% of patients.
• Methyl tert-butyl ether and monooctanoin (Moctanin) are solvents that are infused directly into the bile duct or the gallbladder to dissolve stones.
• Doctors may use shock wave therapy (lithotripsy) to break up stones.

Complementary and Alternative Therapies

You should see your provider for tests before you start any alternative treatment. This will help determine the remedies that are right for the size of your stone and your condition.

Nutrition and Supplements

• Decrease total fat intake, especially saturated fats (which come from meat and dairy products), to lower cholesterol in your diet. Gallstones are primarily made of cholesterol.
• Eliminate food allergens. Eggs, especially, may irritate the gallbladder (as well as being high in cholesterol).
• Eat more fiber. Consider fiber supplements such as flaxmeal (1 tsp. one to three times per day). Combine 1 heaping tsp. of flaxmeal in 8 oz. of apple juice for a drink high in fiber and pectin.
• Drink caffeinated coffee. Some evidence suggests that people who drink caffeinated coffee have a lower risk of gallstones, though study results are mixed. Talk to your doctor before increasing your caffeine intake, as caffeine impacts several conditions and medications.
• Vitamin C (1,000 mg three times a day; reduce dosage if diarrhea develops). A study found that women with higher levels of vitamin C have a lower risk of gallstones, but the same was not true for men.
• Phosphatidylcholine (300 - 2,000 mg per day), a purified form of lecithin, may help dissolve gallstones.
• Choline (1,000 mg per day) and lipase (10,000 NF units with meals) may stimulate gallbladder function.
• Vitamin E (400 - 800 IU/day) promotes bile production.
• Many natural healing practitioners and home remedy books recommend a variety of “gallbladder flushes." These can be extremely dangerous and bring on a severe gallbladder attack. You should talk to your medical doctor before trying any natural remedies to treat gallbladder disease.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs may as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. Tinctures may be used singly or in combination as noted.

• Choleretic herbs reduce the amount of cholesterol present in bile. This may help prevent gallstones. Especially useful are milk thistle (Silybum marianum), dandelion root (Taraxacum officinale), greater celandine (Chelidonium majus), globe artichoke (Cynara scolymus), and turmeric (Curcuma longa). Use these herbs singly or in combination as a tea or tincture (15 - 20 drops), two to three times per day before meals.
• Milk thistle may also be taken in a capsule (420 mg per day).
• Enteric-coated peppermint oil (Mentha piperita) may help dissolve stones (0.2 to 0.4 ml three times a day between meals).

Homeopathy

Some of the most common remedies are listed below. Usually, the dose is 3 to 5 pellets of a 12X to 30C remedy every 1 to 4 hours until your symptoms get better.

• Colocynthis for colicky abdominal pains that are lessened by pressure or bending double
• Chelidonium for abdominal pain that moves to right shoulder area
• Lycopodium for abdominal pain that is worse with deep breaths.

Physical Medicine

Castor oil pack. Apply oil to a clean, soft cloth and place on abdomen. Cover with plastic wrap, place a heat source (hot water bottle or heating pad) over the pack, and let sit for 30 - 60 minutes. For best results, use for 3 consecutive days. Apply to abdomen, especially the gallbladder area, to help reduce swelling.

Acupuncture

Acupuncture may be especially helpful in pain relief, reducing spasm, and easing bile flow and proper liver and gallbladder function.

Following Up

Early surgery usually ends symptoms and recurrence. Stones may appear again in the bile duct, however.

Special Considerations

If you have diabetes or are pregnant, you have a higher risk of complications from gallbladder attacks. If you are pregnant, use choleretic herbs with caution. Milk thistle and dandelion rootare safe in pregnancy. Talk with your health care provider before you take any medication or supplement.

Supporting Research

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:422,427,465

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

Leitzmann MF, Willett WC, Rimm EB, et al. A Prospective study of coffee consumption and the risk of symptomatic gallstone disease in men. JAMA 1999;281:2106-12.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:118,139, 230.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing, 1998.

Nassuato G, Immolo RM, et al. Effect of silibinin on bilary lipid composition. Experimental and clinical study. J Hepatol. 1991;12:290-5.

Sabiston DC, Lyerly HK. Textbook of Surgery. 15th ed. Philadelphia, Pa: WB Saunders Co, 1998

Simon JA, Hudes ES. Serum ascorbic acid and gallbladder disease prevalence among US adults. Arch Intern Med. 2000;160:931-6.

Tuzhilin SA, Dreiling D, Narodetskaja RV, Lukahs LK. The treatment of patients with gallstones by lecithin. Am J Gastroenterol. 1976;165:231-5.

Weiss RF; Meuss AR, trans. Herbal Medicine. Medicina Biologica; 82-89,94-97.