The gallbladder is a small, pear-shaped organ located right below the liver. Gallstones form in the gallbladder when bile, a liquid made in the liver and stored in the gallbladder to help the body digest fats, hardens. These stones can be as small as a grain of sand or as large as a golf ball. The liver and gallbladder are closely interconnected with the intestines, which are often inflamed from Crohn’s. “Crohn’s disease commonly involves the last segment of the small bowel, called the terminal ileum, which is where much of the metabolism of bilirubin occurs,” says Martin Luchtefeld, MD, a colorectal surgeon with Spectrum Health Medical Group in Grand Rapids, Michigan. “Either the Crohn’s disease itself or surgery for Crohn’s can lead to changes in bilirubin metabolism, resulting in a greater incidence of gallstones.” A study published in April 2007 in the journal Hepatology found that people with Crohn’s disease have double the risk of developing gallstones than the general population. During normal bilirubin metabolism, bile salts break up fat, and bilirubin gives bile and stool their yellowish-brown color. If your bile contains too much bile salts, bilirubin, or cholesterol, it can harden into gallstones. If your Crohn’s affects the terminal ileum, the inflamed, diseased ileum fails to absorb bile salts. As a result, cholesterol builds up, and gallstones form.
Pain in the back between the shoulder bladesSteady pain in the upper right quadrant of the abdomen that comes on suddenly and lasts from 30 minutes to several hoursPain under the right shoulder
If you experience any of these symptoms, be sure to notify your doctor. If you develop more severe symptoms — such as prolonged pain that lasts a few hours, a fever, clay-colored stools, nausea and vomiting, or yellowing of your skin or the whites of your eyes — seek medical attention right away. The first treatment option for symptomatic gallstones may be gallbladder surgery; other options may include dissolution therapy, such as using shock waves to break up the stones, or medications that dissolve the stones.
Preventing Gallstones When You Have Crohn’s
“People with Crohn’s disease are more prone to gallstones due to complicated physiology involving malabsorption of bile acids,” says Randy Meisner, MD, a gastroenterologist with Spectrum Health Medical Group in Grand Rapids, Michigan. “Because patients who’ve had surgical intestinal resection for Crohn’s disease are at an increased risk for gallstones, treating the disease to avoid surgery is the best thing they can do to avoid gallstones,” Dr. Meisner says. Beyond trying to avoid surgery, preventing gallstones when you have Crohn’s disease involves the same measures as preventing gallstones for everyone:
Maintain a healthy weight.Exercise regularly, at least 30 minutes a day, five days a week.Eat healthful monounsaturated fats instead of saturated fats.Limit sugary sweets and other sources of added sugar in your diet, as well as refined carbohydrates.Limit caffeine and alcohol consumption.Be aware that certain medications can increase risk for gallstones, such as some cholesterol-lowering drugs and hormone replacement medicines.
When Gallbladder Surgery Is Necessary
The mere presence of gallstones doesn’t mean surgery to remove the gallbladder is necessary, Dr. Luchtefeld says. “Reasons for removing the gallbladder include repeated episodes of cholecystitis [inflammation or infection of the gallbladder] or complications from gallstones, such as pancreatitis or bile duct stones.” Although you can expect gallbladder surgery to ease the pain of gallstones, Luchtefeld says it may bring on an unpleasant and familiar symptom: diarrhea. “The gallbladder normally stores bile produced by the liver until the time of a meal,” he explains. Eating food, especially fatty food, stimulates the gallbladder to release bile into the GI tract via the duodenum (the very first part of the small bowel, just after the stomach). “Once the gallbladder and its storage mechanism are removed, the bile is released continuously into the GI tract," he says. “So if bile is in the GI tract without food, it can be very irritating to the bowel and cause diarrhea.” If you need gallbladder surgery, he recommends finding a surgeon who works with people with Crohn’s on a regular basis. Additional reporting by Christine Gordon
