The risks of undiagnosed gall bladder stones: doctors call for awareness, timely treatment

The Hindu

a day ago

Globally, gallstone disease (cholelithiasis) is prevalent, with varying rates in different regions. In India, the prevalence of gallstones is estimated to be around 4% of the population. In contrast, studies in the West have shown a higher prevalence, with about 10% of American adults having gallstones. Within India, there are regional variations, with higher rates observed in certain areas like North and Northeast India.
What are gallstones?
Gallstones are hardened deposits in the gallbladder, and are increasingly being diagnosed across age groups in India. According to the World Gastroenterology Organisation (WGO), the most common types of gallstones are cholesterol stones ( accounting for approximately 80% of cases, and are primarily composed of hardened cholesterol), pigment stones (dark brown or black and are made of bilirubin), and mixed stones (contain a combination of cholesterol and bilirubin, falling somewhere in between the other two types in composition). Often asymptomatic, they are typically discovered during abdominal imaging for unrelated complaints. 'Many gallstones remain silent for years. But once symptomatic, patients usually present with pain in the upper abdomen, nausea, vomiting, jaundice or fever,' says Piyush Bawane, consultant – medical gastroenterology, Rela Hospital, Chennai.
A sudden onset of abdominal pain, bloating or indigestion after meals may also be initial warning signs. 'People living with weight related health issues , diabetes, during pregnancy or on a high-fat diet are especially at risk,' notes Atul Sharma, clinical director of gastroenterology, Marengo Asia Hospitals, Gurugram.
Gallstones and gallbladder cancer: what's the link?
One of the more serious, but less-discussed complications of untreated gallstones, is gallbladder cancer, a relatively rare but aggressive malignancy. 'There is definitely a correlation between chronic gallstones and cancer of the gallbladder, but not everyone with gallstones develops cancer. The treating doctor assesses each patient's risk based on individual factors.' says Dr. Bawane. 'The persistent inflammation caused by stones can irritate the gallbladder lining over time, potentially increasing the risk of gallbladder cancer, especially with long-standing or large stones.'
Dr. Sharma adds, 'The risk is not universal, but patients with large stones, a porcelain gallbladder, or other chronic biliary abnormalities are particularly vulnerable. Prophylactic removal of the gallbladder is often recommended in high-risk cases to prevent malignant transformation.' Even though prophylactic cholecystectomy ( the removal of the gallbladder to prevent future problems), is generally not recommended for individuals with asymptomatic gallstones. In certain situations asymptomatic patients with risk factors may also benefit from early surgical removal, as gallbladder cancer is often detected late and carries a poor prognosis.
While gallstones have typically affected middle-aged women, recent years have seen a shift in demographics. 'We are seeing more cases in children and teenagers, especially those with obesity or underlying haemolytic disorders,' says Rasik Shah, paediatric surgeon at Lilavati Hospital and H.N. Reliance Foundation Hospital, Mumbai. He urges paediatricians to consider abdominal ultrasounds in children with persistent abdominal pain, and adds that laparoscopic cholecystectomy remains safe and effective in children. He also emphasis that in children, gallstones even though less common than in adults but can occur, often due to underlying hemolytic anemias like thalassemia or as a temporary result of antibiotic use (e.g., ceftriaxone), with some resolving spontaneously.
Two other important paediatric hepatobiliary conditions (liver and bile duct diseases ) include choledochal cysts -- congenital bile duct dilatations that may be detected antenatally and should be surgically treated between 3–6 months to avoid cholangitis --- and biliary atresia, a serious developmental defect of the bile ducts and gallbladder. Biliary atresia presents as jaundice with pale stools in the first month of life and requires urgent surgical intervention before two months of age for optimal outcomes, as delays can lead to liver failure and the need for transplant. Early detection and timely referral to a paediatric surgeon are critical in managing these conditions.
When gallstones go untreated
Neglecting gallstones can result in acute cholecystitis, bile duct blockage, pancreatitis, and in severe cases, sepsis or gallbladder rupture. Thiagarajan Srinivasan, director – Liver Diseases and HPB Surgery, MGM Healthcare, Chennai, says, 'Even a small gallstone can migrate and block the bile duct, leading to life-threatening complications. Around 1–2% of asymptomatic patients can develop serious conditions.'
Compounding this, myths and delays in seeking care remain major challenges, says Dr. Bawane. 'Patients often wait until the pain becomes unbearable or jaundice sets in. Unfortunately, by then, the risks — including that of cancer — would have significantly increased.'
Technology aiding early detection
Experts say that modern imaging techniques have improved detection accuracy, particularly for bile duct stones. 'MRCP (Magnetic Resonance Cholangiopancreatography), contrast-enhanced ultrasound, and Endoscopic Ultrasound (EUS) allow non-invasive and precise detection of even small stones and sludge,' says Dr. Thiagarajan.
While medications like ursodeoxycholic acid can dissolve certain cholesterol stones, they are time-consuming and rarely curative. 'They are not a practical option for most symptomatic patients, given the high recurrence rate,' notes Dr. Sharma. Laparoscopic cholecystectomy , a minimally invasive surgical removal of the gallbladder, is the preferred treatment. 'For complicated cases or patients with common bile duct stones, procedures like ERCP (Endoscopic Retrograde Cholangiopancreatography) may also be necessary,' adds Dr. Bawane.
Surgical advancements now include single-incision laparoscopic surgery, robot-assisted procedures, and use of indocyanine green (ICG) dye for real-time visualisation, ensuring safer removal and reduced bile duct injury.
Preventive care and management
Lifestyle and dietary changes play a critical role in reducing risk. 'A high-fibre diet with whole grains, fruits, and healthy fats like olive oil, combined with regular meals and exercise, can reduce the risk significantly,' explains Dr. Thiagarajan. Rapid weight loss, fasting, and high-sugar diets should be avoided.
For those awaiting treatment, dietary control can prevent attacks. 'Stick to low-fat, small meals and stay hydrated. Avoid fried and greasy food. Symptom relief can be supported by painkillers or antispasmodics under medical guidance,' says Dinesh Ramaswamy, senior surgical gastroenterologist at SIMS Hospital, Chennai.
Post-cholecystectomy recovery is ideally not hard for most patients. 'The liver continues to produce bile, which now drains directly into the intestine. Some may have mild bloating or altered bowel movements initially, but this settles over time,' says Dr. Ramaswamy. 'There is no need for long-term medications, just mindful eating,'he says.
He adds that the number or size of gallstones doesn't always reflect severity. 'Even sludge or small stones can block ducts and cause severe infection. That is why even early surgical intervention is sometimes advised -- to prevent complications, including cancer.'
While there is no gallstone-specific national programme, doctors across hospitals follow protocols recommended by the Indian Council of Medical Research (ICMR) and surgical societies. These promote early ultrasound-based screening, timely intervention, and public education.
'Gallstones are manageable. But we must act early. With rising incidence -- even in young people -- awareness about risks like cancer is crucial,' says Dr. Shah.