Gallstones are solid particles that form in the gallbladder from bile cholesterol and bilirubin. While “silent” gallstones cause no symptoms, others result in abdominal pain and discomfort. Gallstones can potentially lead to severe complications like cholecystitis, pancreatitis, and gallbladder cancer in extreme cases. This article examines whether gallstones can make you feel generally unwell even without complications.
What are gallstones?
Gallstones form when bile contains too much cholesterol, bilirubin, or both. The liver produces bile, a fluid that helps digest fats. Bile is temporarily stored in a small, pear-shaped sac called the gallbladder. If bile contains excessive cholesterol or bilirubin, it can harden into gallstones over time.
There are two main types of gallstones:
- Cholesterol gallstones – Composed primarily of hardened cholesterol. They account for 80% of gallstones.
- Pigment gallstones – Composed of bilirubin and calcium salts. They account for the remaining 20% of gallstones.
Gallstones range in size from a grain of sand to a golf ball. The gallbladder may develop a single large stone or many smaller ones.
Risk factors
Certain factors that increase your risk of developing gallstones include:
- Obesity – Extra weight increases cholesterol levels.
- Rapid weight loss
- Family history of gallstones
- Female sex
- Age over 40 years
- Pregnancy
- Chronic health conditions like diabetes, cirrhosis, and Crohn’s disease
- Taking certain medications like birth control pills
Ethnicity also plays a role. Hispanic populations have the highest rate of gallstone disease, while Asian populations have the lowest risk.
Are gallstones always symptomatic?
Gallstones do not always cause symptoms. In fact, studies estimate:
- 50-70% of people with gallstones experience no symptoms
- 20-40% have occasional mild symptoms
- 5-25% develop severe symptoms requiring treatment
When gallstones do not cause symptoms or complications, they are called “silent” gallstones. These stones often go undiagnosed for years before being detected incidentally during imaging for unrelated problems.
Common symptoms
When gallstones cause symptoms, they commonly include:
- Biliary colic – Severe pain in the upper abdomen that occurs when a stone blocks the cystic duct leading from the gallbladder. This is the most common symptom of gallstones.
- Nausea and vomiting – Can accompany biliary colic.
- Indigestion – Some people experience constant mild indigestion from gallstones.
- Pain after eating fatty meals – Since bile is released after eating to digest fats, pain may occur shortly after consuming fatty or greasy foods.
Symptoms often occur after meals, at night, or during vigorous exercise – times when the gallbladder is most active and likely to contract. Pain may radiate to the back and right shoulder blade. Episodes typically last 30 minutes to several hours.
Can “silent” stones cause general discomfort?
While “silent” gallstones by definition cause no symptoms, some research suggests they may be associated with mild nonspecific symptoms like:
- Bloating
- Belching
- Indigestion
- Intolerance to fatty foods
- Mild abdominal discomfort
However, these symptoms are common in the general population. Experts debate whether links to silent gallstones are correlational or causational.
According to a 2013 review, evidence does not strongly indicate that nonspecific symptoms arise directly due to asymptomatic gallstones. The review concluded that there is no high-quality data proving whether removing silent gallstones improves vague symptoms.
So in most cases, “silent” gallstones likely do not directly cause noticeable discomfort on their own. But they may be associated with mild symptoms like bloating in some individuals. More research is needed on this topic.
Complications
In rare cases, previously silent gallstones may trigger acute complications like:
- Acute cholecystitis – Gallbladder inflammation usually caused by a blocked cystic duct. Symptoms include severe abdominal pain, fever, and nausea.
- Cholangitis – Bile duct infection that causes jaundice, fever, and abdominal pain if stones migrate into the bile ducts.
- Gallstone pancreatitis – Blockage of the pancreatic duct by a gallstone that moved from the gallbladder, resulting in pancreas inflammation.
- Gallbladder perforation – Pressure necrosis and perforation of the gallbladder wall from an obstructing stone.
These complications often require hospitalization and urgent treatment. So while silent gallstones alone may not directly cause noticeable illness, they can sometimes lead to severe complications.
Diagnosis
Since gallstones often cause no symptoms initially, they are usually discovered incidentally through imaging tests performed for other reasons. Gallstones are visible on:
- Abdominal ultrasound – The most common diagnostic test for gallstones.
- CT scan
- MRI
- Endoscopic ultrasound
If symptoms are present, additional tests help confirm the diagnosis:
- HIDA scan – Checks gallbladder emptying function.
- MRCP or ERCP – Visualizes the bile ducts to check for stones.
- Blood tests – Help assess liver function and rule out other conditions.
Should asymptomatic gallstones be treated?
Most experts advise against removing asymptomatic gallstones, as the risks of preventive surgery outweigh the benefits for most patients. According to guidelines:
- Surgery to remove gallstones should only be performed if stones cause symptoms or complications.
- Silent gallstones alone are not an indication for prophylactic cholecystectomy (gallbladder removal surgery).
Exceptions include patients with high-risk conditions like diabetes, cirrhosis, or diseases that suppress the immune system. For them, preventively removing silent gallstones helps avoid future complications.
If gallstones are detected incidentally, most providers recommend watchful waiting rather than immediate surgery. However, patients should monitor for symptoms and follow up annually with an ultrasound.
Treatment
Treatment depends on the patient’s symptoms:
- No symptoms – No treatment needed beyond monitoring for complications.
- Mild, tolerable symptoms – Lifestyle changes and possibly medication to manage discomfort.
- Severe, intolerable symptoms – Surgery to remove the gallbladder (cholecystectomy).
Lifestyle changes like a low-fat diet, weight loss, and regular exercise may reduce mild symptoms. If medication and lifestyle adjustments don’t relieve symptoms, surgery is indicated. Medications don’t dissolve gallstones, but can help manage pain and nausea episodes.
Surgery is always warranted if complications like cholecystitis, cholangitis, or pancreatitis develop. The most common surgery is a minimally invasive laparoscopic cholecystectomy. This is one of the safest and most routine operations done today.
Sometimes a procedure called lithotripsy breaks up stones into smaller fragments that can pass easily from the gallbladder. But this does not prevent recurrence of stones. Most patients with symptomatic stones undergo definitive gallbladder removal.
Conclusion
In summary:
- While “silent” gallstones by themselves don’t usually cause illness, they are associated with mild nonspecific symptoms in some cases.
- Routine prophylactic surgery is not recommended for asymptomatic gallstones.
- However, silent gallstones can sometimes progress to severe complications requiring urgent treatment.
- Symptomatic gallstones are treated by surgical gallbladder removal after attempting medical management.
- Patients with asymptomatic gallstones should have regular monitoring since they may eventually become symptomatic.
So gallstones have the potential to cause discomfort even before they trigger severe symptoms or complications. However, evidence is limited on whether totally silent stones contribute directly to feeling unwell. More studies are needed to clarify associations between asymptomatic gallstones and nonspecific symptoms. But in most cases, prophylactic surgery is not indicated unless gallstones become symptomatic or lead to complications.
