Abnormal concentrations of bile acids, cholesterol and phospholipids in the bile can cause the formation of gallstones, or cholelithiasis. If a stone is pushed out of the gallbladder and lodges in the bile duct, it can cause nausea, vomiting and pain in the upper right abdominal region. These symptoms are known as a gallbladder attack and usually follow a meal of fatty foods. Doctors may recommend an ultrasound to confirm gallbladder disease and surgery to remove the gallbladder. Alternatives to surgery include medications and noninvasive procedures.
Bile Salts
Bile acid preparations thin the bile in the gallbladder and can dissolve small stones comprised of cholesterol. They work very slowly. Treatment may take months or years and is generally recommended only for patients who cannot tolerate surgery. The medications, ursodiol (Actigall) and chenodiol (Chenix), work best on stones smaller than 1.5 cm. According to the National Institute of Diabetes and Digestive and Kidney Diseases, chenodiol can temporarily raise serum cholesterol and may cause liver enzymes to be elevated. Diarrhea is a mild side effect of both drugs, and the treatment does not prevent more gallstones from forming.
Soundwaves
Extracorporeal shock wave lithotripsy (ESWL), is a treatment for gallstones that may be more effective in the elderly and in others who are poor surgical risks. High-energy ultrasound shock waves are aimed at the gallbladder while the patient sits in a tub of water. The waves pass through the abdominal wall and can fragment solitary stones that are less than 2 cm in size. Bile salts may be used in addition to lithotripsy to help reduce broken pieces to a size that can pass through the bile duct into the bowel. Only 15 percent of patients fit the criteria for this treatment, according to the University of Maryland Medical Center. Risks may be severe because of problems caused by the remaining gallstone fragments. Of those who undergo ESWL, almost half later require surgery.
Contact Dissolution Therapy
Certain solvents such as methyl tertiary butyl ether (MTBE), a molecule derived from methanol that is used to oxygenate fuels, can dissolve gallstones when injected into the gallbladder. The procedure is delicate and, as of April 2010, is confined to clinical studies at the hands of experienced doctors, as the Food and Drug Administration has not approved the solvents for this purpose. The chemicals work in a matter of hours to days to get rid of the stones, but the procedure can have serious side effects, including a painful burning sensation.
