University of Iowa Health Science Relations and
Jeffrey Field, MD
Professor of Internal Medicine
First Published: November 2000
Last Revised: September 2004
Peer Review Status: Internally Peer Reviewed
After a meal, while watching television, suddenly you feel a
stabbing pain below your rib cage. This isn't the first time.
Eventually, you find out your pain was caused by gallstones.
Gallstones are a major health problem. About 20 million people in
the United States have them and one million new cases are diagnosed
each year. "Gallstones are the fifth leading cause of
hospitalization," says Dr. Jeffrey Field, professor of internal
medicine at the UI College of Medicine and gastroenterologist at UI
Hospitals and Clinics.
The gallbladder is a small muscular sac located under the liver
that stores bile secreted by the liver. Bile helps you digest fats.
At the turn of the century, physicians believed gallstones were
always the result of a diseased gallbladder. Today they realize that
gallstones, most of which are composed mainly of cholesterol, are
primarily caused by a disturbance in cholesterol metabolism within
the liver. "There is too much cholesterol relative to the amount of
other lipids in the bile," Field says. Cholesterol crystals then form
in the bile and grow into larger stones.
Many people can live for years without knowing they have
gallstones. Pain below the right rib cage, called
biliary colic, is usually the first symptom. "It's a sharp, boring,
intense pain that can radiate around to the back. The gallbladder is
trying to contract, but the opening into the cystic duct is blocked,"
Field says. Nausea, vomiting, and fever can accompany an attack,
which can last several hours. Any foods--but particularly fatty foods--can
precipitate an attack. Obesity, pregnancy, diabetes, prolonged
fasting, cystic fibrosis, certain medications, or a high-calorie diet
can increase your chances of developing gallstones. The condition
becomes more common as you age.
Women are twice as likely as men to develop gallstones,
particularly those in their childbearing years with a family history
of gallstones. Women who have been pregnant develop the disease more
often than women who haven't been, which probably is related to the
drastic change in cholesterol and bile acid metabolism that occurs
during pregnancy, Field says.
If your physician determines that your problem is serious, your
gallbladder may need to be removed in a procedure called a
cholecystectomy. Most surgeries are performed laparascopically, without the need for a large incision or a long hospital stay. Half a million gallbladder surgeries are performed
every year, Field says.
Researchers are looking at the role of diet in the development of
cholesterol gallstones. Eating patterns, calorie content, and
composition of meals may be relevant to the disease.
If you think you have symptoms of gallstone disease, see your