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Gastroenterology  (Expert Forum)
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Reoccurence of gallstones
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Reoccurence of gallstones

by BonnyT, Mar 29, 2003 12:00AM
I was seen in the ER on 3-7 for biliary colic. US revealed a single 1.9 cm. stone. The medical literature indicates a high rate of future attacks leading to complications. I am 54 in excellent health and a nurse who works with obese pts. I am scheduled for a lap cholecsystectomy in 3 weeks with an excellent local surgeon. The GB is normal on the us with the exception of numerous foci that may be cholesterol formations.  How often do you see chronic diarrhea problems after this surgery? (Lasting over a few months.) My GI consult tells me he never sees GERD unless the pt. already has this before surgery-do you agree? If a gallstone is already present does it definitely indicate the GB is not ejecting or is it worthwhile to further test? Do you agree that up to 76% of pts. who have one episode of biliary colic will have continuing GB problems leading to complications? The decision to have surgery is based upon this as I feel the greater risk is to do nothing. Will a high water intake (64-80 oz. daily) keep the bile more dilute after surgery and reduce the risk of esophageal and duodenum cancers (I realize this is rare) but would like your opinion.  I have maintained a 25 lb. weight loss for 8 years, eat a healthy diet, exercise and try to provide a good example for the pts I serve. I find this embarrasing and hard to understand as to what I may have done to cause GB problems as I believe much of our health difficulties are lifestyle related.
Doctor's Answer

by Kevin Pho, MD, Mar 29, 2003 12:00AM
Hello - thanks for asking your question.



Diarrhea is a possible side effect from cholecystectomy - the literature states about 1-2% of patients experience diarrhea.  If this occurs, a medication called cholestyramine can help to bind the additional bile passing into the intestine that can lead to diarrhea.  



GERD caused by the cholescystectomy is rare - I would agree with your GI consult's opinion regarding this.  



Gallbladder ejection fraction is typically used in the abscence of gallstones (i.e. acalculous biliary pain (ABP)).  The normal range is 35-75%.  Patients who suffer from bouts of biliary pain and have lower ejection fraction readings are assumed to have ABP.



I cannot cite exact numbers off the cuff, but I can say it is likely that biliary colic caused by gallstones will continue unless the gallstones are taken care of.  



To my knowledge, there is no data suggesting a higher water intake will decrease the risk of esophageal and duodenal cancers.  



As surgeon has mentioned, gallstones can occur in every type of person.  There is a significant genetic component, so don't feel that you did anything "wrong" that caused you to develop the stones.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (9)

by surgeon, Mar 29, 2003 12:00AM
gallstones can occur in all types of people: thin, fat, atheletic, vegetarians, you name it. It's true that people who have attacks tend to have more. But the majority of problems are simply pain, like you had. More serious problems, such as infection or inflamation of the GB may occur, but are rarely life-threatening. So some people choose to try to avoid further attacks by avoiding eating fatty foods, etc. It isn't an entirely dangerous decision, but in general folks who have biliary colic are better off having the surgery. Diarrhea can result from losing the GB, but the vast majority of people who have the surgery have no side effects at all. We get along fine without a GB because we no longer need to store bile; we eat regularly. All the bile you ever got you still get; it just goes straight from the liver to the duodenum; and since we eat regularly, that works fine in nearly all cases. Cancer as a consequence of cholecystectomy has been raised but not definitively shown. It's highly rare in any case. I've done thousands of cholecystectomies over nearly 30 years and have never seen it. The size of your stone is such that disssolving medications are highly unlikely to work; and people who form stones tend to re-form them as long as there's a GB. The bottom line is that your choices are mainly to have surgery or to put up with attacks; there's not a proven way to prevent them, no matter what you eat or do. Likewise there's no way to know if you will have future attacks, and if so, how often. The odds are high that you will. They may never be more serious than the one that already happened. No crystal ball, unfortunately.

by tessa0825, Mar 29, 2003 12:00AM
Hello, y'all have completely confused me.......I am 11 days post GB surgery....I got along fine and feel 100% better post surgery than what I did pre-surgery...I had a completely non-functioning gallbladder with many stones...Some larger than 5cm...I also have Barrett's (precancerous)esophagus...my Surgeon and my GI Spec. have both told me that having my GB removed would HELP alot with my Barrett's and now I am reading all you medical professionals saying it may CAUSE esophageal cancer???Also, I was a little dismayed to read a memeber of the medical profession  who believes that WE cause GB problems ourselves.....I'am 50 yrs old. and have been on the GERD diet since my Barrett's diagnosis and I have recently lost some weight(total of about 31 lbs) and now I weight 127 lbs....My Dr. told me he thought the weight lose caused the GB attackes....I have not experienced any stomache discomfort or change in bowel habits since surgery...I missed one week of work and I could have went back at 5 days rather than 7.....But there are alot of mixed messages going on in this post, it cant be all ways.....Can someone explain

by kevinmd, Mar 29, 2003 12:00AM
To: tessa
Hi tessa,

To clarify:



1) To my knowledge, cholecystectomy is not associated with esophageal cancer.



2) To be sure, there are several risk factors that may cause gallstones - obesity, cirrhosis, rapid weight loss etc.  However, people with zero risk factors may also develop gallstones.  Nothing is ever certain.



Thanks,

Kevin, M.D.





by tessa0825, Mar 29, 2003 12:00AM
To: kevinmd
Thank-you for clearing up some of that...I'am getting ready to be part of a clinical trial for my Barrett's. I sure wouldn't have had the GB surgery if I thought it accelerated my chances of progression in that direction...Again, Thanks,

Tessa

by daocmom, Mar 29, 2003 12:00AM
I had laproscopic GB surgery 2 months ago, and I still feel ill! I feel run down all the time. Pain