Gallstones are a common occurrence in fat, forty year-old women. This predisposition is due to high estrogens in the diet, e. g., dairy and meat (due to hormone injections). A diet high in vegetables may reduce gall bladder disease. Furthermore, patients with cholestasis (bile duct blockage) need more fat soluble vitamins, e. g., vitamins E, A, D, and K. Methionine has been a useful therapy for cholestasis in some patients. Taurine, which conjugates bile, may also have a role. Most large stones do not pass spontaneously, yet even large stones often remain asymptomatic for a long time. There are new techniques to dissolve them (chemical and ultrasound) to avoid surgery. Actigall is particularly promising for radiolucent stones.
There are many types of gallstones: cholesterol gallstones, calcified gallstones, and pigment gallstones. There are many ways to image gallstones. The easiest is through the ultrasound. X ray and CT scanning can also be very helpful. The gall bladder is also very easily imaged with an oral cholecystogram, or HIDA scan. It is estimated that 30 50 percent of the patients in the United States with gallstones are asymptomatic, with 1.5 percent of these patients undergoing cholecystectomy each year. Risk factors for gallstones include being fat, female, forty, and fertile. Many individuals have chronic cholecystitis from gallstones.
There is a new treatment for the prevention of gallstones in high risk individuals and individuals who are dieting and may be at risk for gallstones. This new drug also may be used as treatment of certain individuals already suffering from gallstones. This is Actigall (ursodiol – a natural bile acid) which is a natural treatment. It is found in small quantities in the normal human gall bladder, and the gall bladder of certain species of bears, where it was originally derived by the Greeks and dried for the treatment of gall stones. Numerous studies suggest that Actigall can result in dissolution of stones. Ninety percent is absorbed in the small bowel after administration. -Actigall is indicated for patients with radiolucent, non calcified, gall bladder stones, less than 20 millimeters in diameter, in whom elective cholecystectomy would not be undertaken because of increased surgical risk. It is probably useful in any individual at high risk for gallstones and those who have chronic dyspepsia.
Actigall will not dissolve calcified cholesterol stones, radiopaque stones, or radiolucent pigment stones. Patients with such stones are not candidates. Also, unremitting acute cholecystitis, cholangitis, biliary obstruction, gallstone pancreatitis, and biliary gastrointestinal fistula are thought not to be candidates for Actigall. It is now thought that chronic hepatitis may also benefit from Actigall. A typical dose of Actigall is 300 milligrams, twice to three times daily depending on the individual. Side effects are relatively limited and include allergy, rash, sweating, hair thinning, cholecystitis, flatulence, headache, fatigue, back pain, and rhinitis. Ultrasound images of the gall bladder should be taken at six month intervals during the first year of therapy.
In the future we hope to be able to identify early thickening of bile so the therapy can be used earlier for prevention. Gallstone dissolution with Actigall treatment generally requires 6 to 24 months of therapy. Dissolution progression may be confirmed by sonography in as early as six months. Complete dissolution does occur in many patients and recurrence of stones within 5 years has been observed in up to 50% of patients who dissolve their stones using bile acid therapy.
Eric R. Braverman, M.D.
Dr. Braverman is a Summa Cum Laude and Phi Beta Kappa graduate of Brandeis University and NYU Medical School, did brain research at Harvard Medical School, and trained at an affiliate of Yale Medical School. He is acknowledged worldwide as an expert in brain-based diagnosis and treatment, and he lectures to and trains doctors in anti-aging medicine.