Gallstone Treatments and Medications

Gallstones are hardened lumps of cholesterol or other substances that form in the gallbladder: a small, pouch-shaped organ in the upper right side of the abdomen. Also called cholelithiasis, gallstones form when cholesterol or bilirubin, a waste product formed from the breakdown of red blood cells in the liver, becomes oversaturated in the gallbladder. When these substances accumulate in the gallbladder, they can mix with gallbladder mucus to form sludge. Crystals may form in this sludge and, over time, grow into hard, stone-like masses. Gallstones can also form when the gallbladder doesn’t empty sufficiently or regularly. Most gallstones are very small, but some can grow large enough to cause symptoms and require treatment.

How are gallstones diagnosed?

Gallstones are primarily diagnosed based on symptoms, a physical exam, blood tests, and imaging tests, such as an ultrasound. Asymptomatic gallstones are typically discovered by accident on an MRI or ultrasound performed for some other reason. Most cases, however, are discovered once symptoms of gallstones begin.

Patients with gallstones typically have symptoms such as:

• Episodes of sharp, constant pain in the upper right area of the abdomen or below the breastbone

• Pain in the back or right shoulder

• Nausea

• Vomiting

Complications of gallstones may involve symptoms such as:

• Constant pain in the upper right area of the abdomen

• Fever

• Tenderness in the gallbladder area

• Jaundice (yellowing of the skin)

• Dark urine

• Fast heartbeat

Once gallstones are suspected, a primary physician or gastroenterologist will order an ultrasound, which, in most cases, provides enough information for a diagnosis. Ambiguous cases or impacted stones may require different imaging tests, including:

• Hepatobiliary iminodiacetic acid (HIDA) scan. Also known as cholescintigraphy, a HIDA scan is the most accurate method to detect blockages. The scan follows a radioactive substance as it passes through the liver into the gallbladder and out to the intestine. The whole process usually takes about one to two hours. 

• CT scan: A CT scan can show gallstones, or it may be used to detect complications of gallstones, such as acute cholecystitis or pancreatitis.

• Magnetic resonance cholangiopancreatography (MRCP). An MRCP is an MRI of the liver, gallbladder, bile ducts, and pancreas. It may be used when the healthcare provider suspects complications such as cholecystitis, pancreatitis, liver damage, or infection. The scan typically takes about 40 minutes (about twice as long as a routine MRI).

• Endoscopic retrograde cholangiopancreatography (ERCP). An ERCP is an X-ray of the bile and pancreatic ducts after a contrast dye has been introduced into the bile ducts using an endoscope. The patient is sedated during the procedure, which normally takes 30 to 90 minutes. One advantage of the procedure is that the physician can use the endoscope and electrically generated heat (electrocautery) to widen narrow ducts. They can then remove any stones causing bile duct blockage.

Gallstones treatment options

Treatment of gallstones depends on the symptoms. Many people with gallstones do not experience symptoms, so treatment consists of lifestyle and dietary changes to reduce the risk of symptoms, as well as watchful waiting. When symptoms appear, surgical removal of the gallbladder may be required. This procedure is called a cholecystectomy. In addition, patients may require antibiotics or other treatment. In some cases, patients with mild symptoms may be given pain medicines and monitored.  

Surgery

The gold standard for treating symptomatic gallstones is the surgical removal of the gallbladder, called laparoscopic cholecystectomy. The removal of the gallbladder usually fixes the problem permanently. Typically performed by a general surgeon, four small incisions are made in the abdomen through which instruments and a laparoscope are inserted. At the end of the laparoscope is a camera that feeds an image to a video monitor to guide the surgeon in removing the gallbladder and the cystic duct. The surgeon may also need to remove impacted stones using ERCP. 

A cholecystectomy may alter digestion, so common side effects may include difficulty digesting fats, diarrhea, constipation, and gas. Because the abdomen is inflated with gas to perform the surgery, patients often experience shoulder pain for a few days after the surgery.

Medications

Some medications dissolve gallstones, but they only work in certain circumstances. They are not very effective in the long-term, so they are prescribed only for people unable to undergo surgery or who have certain types of gallstones.

Extracorporeal shockwave lithotripsy (ESWL)

ESWL, commonly used to break up kidney stones, is an alternative for people unable to undergo surgery. High-energy sound waves are directed at the gallstones to break them up, allowing them to pass through the bile ducts. It can be an effective treatment for small gallstones. However, because it might not fix the underlying problem, there’s a possibility that gallstones can return. 

Types of gallstone medication

The standard treatment for symptomatic gallstones is surgical gallbladder removal. Pain medications and other drugs may be used to ease pain during a gallbladder attack. Medications that shrink gallstones may be used in special but rare cases.

NSAIDs

Nonsteroidal anti-inflammatory drugs are commonly used as first-line therapy to manage gallstone pain. Prescription NSAIDs such as diclofenac, ketorolac, flurbiprofen, or celecoxib are commonly administered either orally or intravenously. NSAIDs can help relieve pain, inflammation, and fever from gallstones or complications caused by gallstones.

Opioids

In patients who do not respond to or cannot take NSAIDs, an opioid such as morphine or meperidine may be used to control gallstone pain.

Anticholinergics (spasmolytic drugs)

The pain of a gallbladder attack (also called biliary colic) is often triggered by muscle contractions in the bile duct to try to move the stone. Spasmolytic drugs such as hyoscyamine and scopolamine relax the gallbladder by blocking a chemical (acetylcholine) that nerves use to signal muscles to contract. 

Gallstone dissolution agents

Patients who are unable to undergo surgery may be prescribed medications that promote the dissolution of gallstones. Ursodiol and chenodiol are drugs that work by decreasing the amount of cholesterol secreted by the liver. As cholesterol levels in the gallbladder go down, cholesterol crystals and gallstones slowly dissolve. The treatment takes six to 12 months, or even longer, but less than 1 out of 10 patients have gallstones that are treatable by dissolution agents. 

Over-the-counter gallstone medicine

There are no over-the-counter (OTC) medicines that treat gallstones. However, healthcare providers may recommend OTC pain relievers such as Tylenol (acetaminophen) or Motrin (ibuprofen) for gallstone pain. Check with your healthcare provider for a specific recommendation based on your health history. 

Best medication for gallstones

Most gallstones do not cause symptoms, so the primary treatment is to watch and wait. The standard treatment for symptomatic gallstones is the surgical removal of the gallbladder. Medications may be used for pain control and, in patients unable to undergo surgery, to dissolve gallstones. There is, then, no “best” medication for gallstones, only the most appropriate treatment for the symptoms and situations of individual patients. 

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Best medications for gallstones