Clinical Review Fortnightly review

Gallbladder disease

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7200.1745 (Published 26 June 1999) Cite this as: BMJ 1999;318:1745
  1. Malcolm C Bateson, consultant gastroenterologist
  1. General Hospital, Bishop Auckland, County Durham DL14 6AD
  • Accepted 12 March 1999

Gall stones are very common and their prevalence increases appreciably with age; it is also determined by sex, body weight, and race. Fortunately, most gall stones do not cause severe symptoms such as colic and jaundice. They are best detected by ultrasonography, although endoscopic retrograde cholangiopancreatography and magnetic resonance scanning may be required for duct stones.

Troublesome gall stones are generally treated by cholecystectomy, and two thirds of these procedures are carried out by laparoscopy. Duct stones may be treated with endoscopic retrograde pancreatography, sphincterotomy, and extraction, or by open choledochotomy. Dissolution with ursodeoxycholic acid may be a useful reserve treatment for some patients. Persistent symptoms after surgery are common and are sometimes difficult to treat.

Summary points

  • Operations to remove gall stones have become more common, probably because indications for these have changed

  • 70% of stones in the gall bladder do not cause symptoms

  • Cholecystectomy relieves pain, but 50% of patients still have digestive symptoms afterwards

  • Laparoscopic cholecystectomy has not reduced overall morbidity, mortality, or the cost of surgery because operations are now carried out in people who are older and less fit

Gallbladder disease

Why we have a gall bladder at all is something of a mystery. Many animals such as horses, pigeons, and rats manage quite well without one. The gall bladder functions as an optional store and concentrator for the bile secreted by the liver. Bile acids are important in rendering the fats in the intestine soluble before their digestion and absorption. The gall bladder contracts to eject high concentrations of bile into the duodenum when a fatty meal is consumed—but it does the same thing when any other sort of meal is taken or even when water is drunk. The gall bladder is clearly not essential to human digestion since patients who have had a cholecystectomy have no problems …

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