The Gallbladder Syndrome
Gallbladder dysfunction is one of the most common health problems today. Unfortunately, it is also one of the most misunderstood. Clinicians frequently refer to it as the 5-F Syndrome-fair, fat, female, fertile and over forty. Right shoulder pain accompanied by flatulent dyspepsia is considered to be the best indicator.
Once the presence of gallstones is confirmed the usual procedure is to schedule surgical removal of the gallbladder. Over 600,000 cholecystectomies are performed in this country every year despite overwhelming evidence that most are not necessary. Repeated warnings have been printed in medical journals against this practice, but to no avail.
The key points of gallbladder dysfunction and gallstones:
1. The removal of gallstones does not change the consistency of bile. Gallstones develop because poor digestion causes the bile to become too thick. The bile will remain thick even after the stones are removed unless digestion is improved.
2. Gallstones are extremely common. Their occurrence in women is roughly double their occurrence in men. The occurrence and size of the stones increases with age and depending on the ethnic group, their incidence can range as high as 25% to 44% of the population.
3. Gallstones usually do not cause symptoms. Three major studies involving more than 3,000 patients found that 67% of all confirmed cases of gallstones were asymptomatic. Other studies placed the figure above 80%.
4. Patients with gallstones who are asymptomatic are likely to remain so. Studies indicate the chance of asymptomatic gallstones becoming symptomatic in the next five years is less than 10%. This percentage decreases to less than one percent after 10 years.
5. The majority of gallstones are found by chance-even in patients with abdominal pain. More gallstones are being detected incidentally with the increased use of the abdominal ultrasound. Therefore, the opportunity to recommend gallbladder removal is increasing.
6. Once the presence of gallstones is confirmed the usual procedure is to schedule surgical removal of the gallbladder.
7. Gallbladder removal does not always relieve symptoms that are traditionally thought to be caused by gallstones. Most studies show complete relief of symptoms in 75% to 80% of patients after surgery. However, studies concentrating on the relief of symptoms in those that had symptoms before surgery indicate relief in only about one-half of the cases! The most persistent symptoms remaining after surgery are flatulent dyspepsia and chronic, dull pain in the upper right quadrant.
8. An acute gallbladder attack should be used as the indication for surgery-not the accidental finding of gallstones. An acute attack consists of severe “colicky (spasmodic wave-like) pain” or constant (cystic duct obstruction) pain lasting up to four hours, which is occasionally accompanied by low-grade fever (only 13% of the time), and characteristically followed by a “washed-out” feeling for up to 24 hours. The occurrence of constant pain is much more common (57% to 94%) than the colicky wave-like pain.
9. Don’t bet on referred pain to the right scapular area. Radiation of pain outside the abdomen occurs only 60% of the time. The pain can radiate anywhere in the torso, including both flanks, both shoulders and scapula, and the mid-thoracic area (20%).
10. Gallbladder emptying has been shown by ultrasound to be unrelated to the fat content of a meal. In fact, there is no proof that gallbladder attacks are precipitated by eating. In one study “fatty food” intolerance was more common in the controls than in those patients with confirmed gallstones.
11. Bloating, belching, and flatulence are no more common in patients with gallstones than in the controls without gallstones. Therefore, a cause and effect relationship cannot be established. Since these symptoms often persist after surgery they cannot be caused by gallstones. Obviously, it is important for your patients to know this.
By Howard F. Loomis Jr., D.C.