Reoccurence of gallstones

[BonnyT]

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.

[tessa0825]

Hi, I can certainly understand anxiety where illness is concerned....The "C" word to me is my greatest fear...I had cancer in 1995 that had spread to my lymph nodes...I had three surgeries and Chemo...I also had a wonderful oncologist at a cancer center about 100 miles from where I live...He was an expert on knowing how to keep people from becoming depressed and over anxious...It was a fight for 5 yrs. but I survived it..I was declared cured and cancer-free in 2000 and my cancer Dr. has since retired....It took me probably 2 and a half or three yrs. after my surgeries and treatments to get all my strength back....Then about a yr ago my family Dr. told me he was sending me to a Hemotologist Oncologist because of a persistent high white blood cell count.I almost went in to a panic...Then he also said he was sending me to a GI Spec. because (unknown to me) he had done a CEA that came back in the range that is consistent with colon cancer....Well, I was sure I had cancer and that it had spread and I was dying...EXCEPT, noone could find any cancer...Bone marrow was ok, Colonoscopy had a few problems and he removed polyps but I had NO cancer there...I had been having heartburn and alot of problems swallowing and that finally led them to my esophagus and all kinds of problems.strictures, erosions, 3 ulcers, lg hiatal hernia...After the ulcers had healed and he dialated the strictures he was able to take biopsies that confirmed long segment (5.5cm) Barrett's esophagus with low-grade dysplasia....Then wouldnt ya know it, I started having gallbladder attackes...I am still seeing the hemotologist oncologist (he just isnt ready to release me yet) and I will absolutely see the GI Spec. for all my life and have biopsies every few months....So when I read about GB surgery might increase the risk of esophageal cancer I wondered what the heck that was all about....I didnt mean to sound critical and if it came out that way then I apologize....Best of luck to you with your up coming surgery...For me that was the easiest surgery I ever went through...Had it on Monday two weeks ago and by Wed. of that week I felt good...Thanks......Tessa

[tessa0825]

Thank-you for responding...As for my GI Dr. and my surgeons thought on having the GB removed might help the Barrett's..It might have been relative to the vomitting caused by the GB attackes, I'm not sure. However, when I saw the surgeon this past week (post-op) he mentioned again that my Barrett's would be better now..He also says he wants to follow me for awhile, which I thought was strange..I see him again in 6 weeks..Is that normal?Thanks, Tessa

[BonnyT]

Thanks to Dr Kevin as well as Surgeon as to the percentages of complications from cholecystectomy. I feel more confident and reassured about this decision. Surgeon's view of the GB from an evolutionary standpoint was especially interesting-we discuss the "thrifty gene" concept in much the same manner as it drives that desire to eat all you can at one sitting. Do you think perhaps our GB has not caught up with the need to constantly eject bile and just becomes less effective over time? Apologies are in order if the esophageal and duodenum cancers needlessly concerned anyone. The most definitive studies I could find (the Swedish Cohort studies} conclude that these cancers are EXTREMELY RARE and should NEVER be a reason not to undergo a needed cholecystectomy. Most GI texts and I imagine physicians,indicate that the risk of developing cancer of your GB after it becomes calcified or diseased are MUCH higher than these rare cancers. My question was whether or not the bile is more dilute with a high water intake, thus decreasing its concentration with the gastric mucosa. And to Tessa, you saw that both physicians see all kind of folks with this problem. My feelings of embarassment over having a gallstone are not logical or medically significant they are just feelings. When an otherwise healthy person has a few weeks to think about elective surgery it is possible to whip oneself into a real frenzy of worry and fear! When I asked my surgeon, who is an extremely kind man as well as skilled, if he thought I might hemmorhage in the OR since I take fish oil capsules, he asked gently if I might need a "little something" for anxiety! Imagine that! I took him up on the offer and am sleeping much better. I'm glad you are recovering so well, take care of yourself and I pray you will be feeling better with each day.

[surgeon]

the cancer issue regarding GB surgery was in regard to colon cancer. And the data really are questionable at best. It's not a concern, in my opinion and that of most people. There's no reason to say removing the GB would help Barret's esophagus that I know of.

[daocmom]

I had laproscopic GB surgery 2 months ago, and I still feel ill! I feel run down all the time. Pain in my shoulderblade, and upper abdomin. I can't eat squat, and lost a lot of weight (Hey, I guess that was a plus)! At least before my surgery I only felt ill when I was having an attack. Granted, it was worse then I imagine a heart attack to feel like, but at least I got along the rest of the time. Maybe you want to think about a cleansing routine. I wish I knew about it before I had the surgery, but mine was emergency surgery because I had other problems.
Check out this other forum for liver and Gall bladder cleansing...
http://www.curezone.com

[tessa0825]

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

[kevinmd]

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.

[tessa0825]

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

[surgeon]

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.

[Kevin Pho, MD]

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.