Only a quarter of people with gallstones typically require treatment. That's fortunate, because every year nearly 1 million Americans are diagnosed with these little pebbles, which are primarily made of cholesterol and bile salts.
Getting rid of them typically requires removal of the gallbladder, one of the most common U.S. surgeries.
Gallstones can get blamed for symptoms caused by other, more elusive culprits, such as irritable bowel syndrome, says Robert Sandler, chief of the division of gastroenterology and hepatology with the University of North
Carolina School of Medicine. An ultrasound test might pick them up while missing the real problem. If you're told you need to have gallstones out but they're not bothering you, get a second opinion, he advises.
Removal may be necessary if the stones instigate inflammation or infection of the gallbladder, pancreas, or liver. This can happen if a stone moving out of the gallbladder gets stuck—blocking the flow of bile—in the ducts between the liver and the small intestine.
The pain of a gallstone lodged in a duct usually comes on quickly—in the right upper abdomen, between the shoulder blades, or under the right shoulder—and means a trip to the ER is needed, as may fever, vomiting, nausea, or pain lasting more than five hours. Gallbladder removal can be performed laparoscopically and more recently has been done without an external incision by going through the mouth or vagina.
Obesity is a risk factor for gallstones, and it's theorized that they develop because of a shortage of fiber and an excess of fat in the western diet. Losing weight—then regaining it—also seems to set the stage for gallstones. In a 2006 study of men, the more frequent the weight cycling and the larger the number of pounds shed and regained, the greater the odds of gallstones. Women, especially those who are pregnant or taking birth control pills, face increases in gallstone likelihood as well.