Gall Bladder Issues

Patients with irritable bowel syndrome (IBS) and other digestive problems such as constipation, diarrhea or abdominal pain often wonder if they have a problem with their gallbladder. Problems with the gallbladder can indeed cause these symptoms. However, many people find that having their gallbladder removed did little or nothing to help their IBS, or even made it worse.

What does the gallbladder do?
The gallbladder does exactly what its name describes; it is a small bladder that stores gall. Gall is more commonly known as bile. Bile is produced by the liver and piped over to the gallbladder via the bile duct.

What is bile?
Bile is a highly concentrated yellow green fluid that contains bile acids. Bile acids are important for digesting fats. When you eat, your gallbladder contracts and secretes bile into the small intestine to help you digest your food. If your gallbladder has been removed then it will be more difficult for you to digest fats. In such cases, eating too much fat may cause loose stools.

When does that gallbladder need to be removed?
In some people, stones develop inside of the gallbladder. These stones, when small, can become lodged in the bile duct, which can cause severe pain and be very dangerous if they also clog the pancreatic duct. Larger stones are not able to pass into the bile duct, but their presence can cause severe pain. Sometimes this is worse when the gallbladder is contracting. In either case, removing the gallbladder usually relieves the pain and you feel much better.

When is it questionable to remove the gallbladder?
It is often tempting for physicians to blame the gallbladder for abdominal pain and digestive problems even when there is little or no evidence that the gallbladder is the culprit. Itís a relatively simple procedure, and most people donít miss it too much. If stones are present, then the decision is easy to make.
However, in some cases physicians recommended that the gallbladder be removed even when stones are not apparent on any exams. The recommendation is based primarily on symptoms and a lack of any other visible problem. Gallbladder function tests also may indicate that the gallbladder is not functioning at 100%. However, that does not mean that it is the cause of the problem. If the gallbladder is functioning at a below normal level, removing it will only guarantee that it will not function at all.

Studies (see below) have shown that patients with IBS symptoms and/or abdominal pain are more likely than others to have gall bladder removal surgery (cholecycstectomy) when they do not have gall stones. This exposes the patient to the increased (though small) risks of surgery and to further digestive problems caused by the abscence of a gall bladder. Testing for food allergies and other causes of IBS symptoms, and treating those conditions can enable patients to avoid unnecessary surgery and achieve good digestive health.

 

Medical Research on Gall Bladder Issues

Corazziari et. al. (2008). Gallstones, cholecystectomy and irritable bowel syndrome (IBS) MICOL population-based study. Dig Liver Dis. 2008 Apr 9. [Epub ahead of print]
"CONCLUSIONS: Irritable bowel syndrome subjects have an increased risk of cholecystectomy that is not due to an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications."

Cole et. al. (2005). IThe incidence of abdominal and pelvic surgery among patients with irritable bowel syndrome. Dig Dis Sci. 2005 Dec;50(12):2268-75.
"The incidence of gallbladder surgery was threefold higher in IBS patients than the general population. Patients with IBS have an increased risk for abdominopelvic and gallbladder surgery and, thus, an associated risk for experiencing morbidity and mortality associated with these surgical procedures."

Kennedy TM, and Jones RH. (2000).Epidemiology of cholecystectomy and irritable bowel syndrome in a UK population. Br J Surg. 2000 Dec;87(12):1658-63.
"CONCLUSION: Symptoms of IBS may cause diagnostic confusion and unproductive surgery. Cholecystectomy may cause IBS-like symptoms, a single underlying disorder may produce symptoms in both gastrointestinal and biliary tracts, or the associations might be due to a combination of these factors."

Thijs C, Knipschild P. (1998). Abdominal symptoms and food intolerance related to gallstones. J Clin Gastroenterol. 1998 Oct;27(3):223-31.
"Gallstones were associated with mid upper abdominal pain in the screening study, and with mid upper abdominal pain, biliary pain, and colic (each independently) in the clinical study. When these symptoms were absent (and only dyspeptic symptoms or food intolerance was present), gallstones were not more common than expected from the general population prevalence (estimated from the screening study)."

 

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