Gallbladder Stones (Cholelithiasis)

Gallbladder stones, or cholelithiasis, refer to the presence of calculi (“stones”) in the gallbladder, a small organ located beneath the liver that stores bile. After meals, the gallbladder contracts and releases bile into the small intestine, aiding fat digestion.

This is a common condition: approximately 10% of the European population has gallstones, with a higher prevalence in women and increasing incidence with age.

Symptoms
Most patients (around 80%) are asymptomatic. When symptoms occur, they include:

• Pain or colic in the upper right abdomen, which may radiate to the back, chest or left side;
• Sudden episodes of pain lasting minutes or hours, sometimes occurring at night;
• Nausea, vomiting, sweating and pallor associated with pain.

Stone formation occurs due to an imbalance in bile components, particularly cholesterol and bile pigments, or incomplete emptying of the gallbladder.

Risk factors include:

• Obesity;
• Diet high in animal fats and low in fruits and vegetables;
• Physical inactivity;
• Rapid weight loss;
• Prolonged fasting;
• Use of hormones or contraceptives;
• Advanced age, female sex, family history, diabetes, pregnancy, haemolytic anaemias and cirrhosis.

Abdominal ultrasound is the most appropriate diagnostic test and may be complemented by abdominal CT. Many cases are discovered incidentally during imaging performed for other reasons.

Treatment of gallbladder stones depends on the presence of symptoms and the risk of complications. In asymptomatic patients, only 15–25% will develop symptoms or complications over the following 10–15 years, so treatment is not always necessary. In symptomatic patients or those at high risk, surgical removal of the gallbladder (cholecystectomy) is the treatment of choice, preferably via the laparoscopic approach, as it is less invasive and allows faster recovery. Other therapeutic options, rarely used, include medical dissolution of stones or shock-wave fragmentation (lithotripsy), while stones in the bile ducts may require endoscopic intervention (ERCP).

Prevention of gallstone disease is based on correcting risk factors, including maintaining a healthy body weight, adopting a balanced diet rich in fruits and vegetables and low in animal fats, engaging in regular physical activity, and cautious use of hormones and contraceptives.