Highlights of this issue
◎ What is the pathogenic mechanism of common gallbladder diseases
◎ Which groups of people are prone to common gallbladder diseases
◎ How do Western medicine and traditional Chinese medicine view the treatment of gallbladder diseases
◎ What is a better way to deal with gallbladder problems
Chronic cholecystitis and cholelithiasis are almost the most common gallbladder diseases. People who don’t know about them may find these diseases elusive, difficult to treat and prone to recurrence.
According to relevant studies, most patients with gallstones will relapse within 3 years after surgery. If they have bad living habits, the recurrence rate/recurrence speed will greatly increase/accelerate; and the recurrence of chronic cholecystitis is even more common. Therefore, many doctors will warn patients: “If you don’t pay attention to your diet, the recurrence rate of cholecystitis can be said to be 100%.”
So are these chronic gallbladder diseases really impossible to deal with better and avoid recurrence? In this article, Dianhetang will use 10 questions and 10 answers to take readers to an in-depth understanding of these two common gallbladder diseases, helping everyone to get out of the treatment misunderstandings and avoid the easy recurrence of such diseases.
10 Key Questions About Gallbladder Disease
01
What are the common symptoms of chronic cholecystitis/gallstones?
| Disease | Common symptoms |
| Chronic cholecystitis | About 70% of patients with chronic cholecystitis have no obvious symptoms.Symptoms are common:① Abdominal pain: Abdominal pain is the most common symptom of chronic cholecystitis, with an incidence rate of about 84%. High-fat and high-protein diets can easily induce abdominal pain. It often manifests as paroxysmal discomfort or dull pain in the right upper abdomen, and a few manifest as colic, which can radiate to the back and generally last for a few hours before being relieved.② Indigestion: Biliary indigestion is a common manifestation of chronic cholecystitis, which occurs in about half of the patients. It manifests as indigestion symptoms such as belching, nausea, and abdominal distension. |
| Gallstones | The symptoms of different types of gallstones are not exactly the same.Gallstone① Biliary colicGallstones in the gallbladder cause gallbladder spasms, which manifest as biliary colic. Biliary colic occurs because after the gallstones are lodged in the gallbladder, the bile in the gallbladder cannot flow out, causing the pressure in the gallbladder to continue to increase, which causes the gallbladder to contract again and again in an attempt to expel the gallstones, causing the patient to feel colic.② OtherWhen acute cholecystitis develops, there may be obvious tenderness in the right upper abdomen, and severe patients may also develop suppurative cholecystitis. Due to long-term chronic stimulation of stones, a small number of patients may develop gallbladder cancer.Extrahepatic bile duct stones① BellyacheThe pain is located in the right upper abdomen and is mostly intermittent colic. It is mostly caused by stones being stuck in the lower part of the common bile duct when they are discharged with bile, stimulating spasm of the common bile duct.② Chills and high feverThe stones get stuck in the main bile duct, causing bile duct obstruction. When the bile duct is obstructed, intestinal bacteria take the opportunity to invade the bile duct and cause cholangitis, followed by systemic infection, manifested by chills and high fever, with body temperature as high as 39~40℃③ JaundiceAfter bile duct obstruction, bile excretion is blocked and jaundice occurs. The severity of jaundice depends on the degree of stone obstruction, whether it is complete or incomplete. |
02
What is the basic situation of chronic cholecystitis/gallstones?
Chronic cholecystitis
There is currently no nationwide epidemiological data on chronic cholecystitis in China. Many relevant medical reports and clinical data show that the incidence of chronic cholecystitis is about 10%-28%. With the increase of individual age and the continuous improvement of national living standards, the incidence of chronic cholecystitis has gradually increased.
Gallstones
The incidence of gallstones in adults is about 10%-15%, with more women than men, and the most common age is 40-60 years old. In addition, the incidence of gallstones is also related to region, ethnicity, and eating habits. With the improvement of living standards and changes in eating habits, the incidence is rising year by year, especially in economically developed areas.
03
What are the types of chronic cholecystitis/cholelithiasis?
| Chronic cholecystitis |
| ① Chronic calculous cholecystitis60% of patients with chronic calculous cholecystitis have no obvious clinical symptoms and are discovered during physical examination or other upper abdominal surgery. When the gallstones cause obstruction of the cystic duct, it often manifests as distension and discomfort in the right upper abdomen, similar to the symptoms of chronic gastritis, and patients often dislike greasy food; when patients change their positions in bed at night, the stones block the cystic duct and temporarily obstruct it, causing pain in the right upper abdomen and epigastrium, so there is often abdominal pain at night. |
| ② Chronic acalculous cholecystitisChronic acalculous cholecystitis refers to chronic cholecystitis with a course of more than three weeks due to non-calculous causes. The patient does not have gallstones, and it is mostly caused by recurrent acute or subacute cholecystitis or repeated bacterial, viral and other microbial infections of the gallbladder. The patient mainly presents with long-term and recurrent pain in the gallbladder area or upper abdomen, accompanied by jaundice. When the infection is severe, systemic symptoms such as fever and chills often occur. Involvement of the liver can cause liver enlargement, portal hypertension and other accompanying symptoms. |
| Gallstones |
| By stone location:① GallstonesRefers to stones located in the gallbladder. This type is the most common. Most patients have no obvious symptoms, which are called “quiet stones”. Those with symptoms mainly show colic in the right upper abdomen, or dull pain in the upper abdomen, which can be easily misdiagnosed as gastric disease.② Extrahepatic bile duct stonesIt is divided into primary stones and secondary stones. Primary bile duct stones refer to stones that form spontaneously in the bile duct; secondary bile duct stones are stones discharged from other parts, mainly from the gallbladder. A few originate from the intrahepatic bile duct. Bile duct stones can easily lead to bile duct obstruction, which in turn causes inflammation, manifested as abdominal pain, high fever and chills, jaundice and other symptoms.③ Intrahepatic bile duct stonesRefers to stones that form in the bile ducts inside the liver. This type of stone is mainly seen in patients in Asian countries such as China. |
| According to stone composition:① Cholesterol stonesThe main component is cholesterol. The cross section of pure cholesterol stones shows radial crystals, and the cholesterol content is generally >90%. Mixed stones mainly composed of cholesterol have a brown-green surface, with visible stratification on the cross section, and the cholesterol content is >60%.② Pigment stonesThe main component is bile pigment. Its cholesterol content is usually less than 45%, and it is often reddish brown or dark brown. The cross section of a larger stone can show a tree ring-like layered structure. The other type is pure bile pigment stone, which is mostly black. |
04
What is the key cause of chronic cholecystitis/gallstones?
Factors that lead to common gallbladder diseases include unhealthy lifestyle habits, such as eating greasy food and sitting for long periods of time, as well as infection, obesity and some other diseases such as diabetes and cirrhosis. But no matter how different the external factors are, the key to the onset of most gallbladder diseases is “stagnation.”
Mechanisms of Stasis Leading to Gallbladder Problems
When bile in the gallbladder is not discharged smoothly and stagnation occurs, the bile will become over-concentrated. The concentrated bile will stimulate the gallbladder wall, making it rough, thickened, fibrotic, and ischemic, leading to gallbladder deformation and obstruction of the gallbladder neck outlet, causing cholecystitis. When bile is blocked for a long time and over-concentrated, crystals will precipitate in the bile, and the crystals will gradually accumulate, forming gallbladder stones or bile duct stones.
Especially when overeating, eating greasy food, having low immunity or infection occurs, the irritation will be aggravated, and symptoms such as discomfort and pain in the upper abdomen or right upper abdomen will appear. The pain may involve the back or right shoulder blade, and may be accompanied by symptoms such as nausea and vomiting.
05
What are the common complications of chronic cholecystitis/cholelithiasis?
| Chronic cholecystitis |
| ① Acute attack of chronic cholecystitisWhen chronic cholecystitis occurs acutely, it often leads to bile stasis in the gallbladder and infection. If the infection is not treated in time, gangrene will occur on the gallbladder wall, which is a secondary infection of putrefactive bacteria after gallbladder necrosis. If it is allowed to develop, it will lead to gallbladder perforation and even septic shock. |
| ② Acute biliary pancreatitisFor patients with acute biliary pancreatitis combined with common bile duct obstruction or cholangitis, if the onset is very rapid and the symptoms are very severe, surgical treatment may be required. |
| ③ Mirizzi syndromeMirizzi syndrome is a complication of cholelithiasis, which refers to a series of syndromes characterized by cholangitis and obstructive jaundice due to varying degrees of obstruction of the common hepatic duct or common bile duct caused by stone incarceration in the gallbladder neck or cystic duct and/or compression or inflammation caused by other benign diseases. |
| ④ Calculous intestinal obstructionCalculous intestinal obstruction is caused by the formation of a fistula between the gallbladder and the intestine (the most common is the cholecystoduodenal fistula), which allows the stones to enter the intestine through the fistula. It usually occurs in the ileocecal region. |
| ⑤ Gallbladder cancerGallbladder cancer is the most serious complication, and its diagnosis mainly relies on imaging examinations such as abdominal ultrasound, CT, MRI, and endoscopic ultrasound. |
| Gallstones |
| ①Acute/chronic cholecystitisGallstones can lead to gallbladder inflammation, and severe acute inflammation can cause pain and fever. |
| ② Common bile duct obstructionCommon bile duct obstruction can lead to jaundice and bile duct infection |
| ③ Pancreatic duct obstructionIf gallstones block the pancreatic duct, pancreatitis may occur, in which the patient experiences severe, persistent abdominal pain. |
| ④ Gallbladder cancerPatients with gallstones have a higher risk of developing gallbladder cancer than normal people. |
06
Which groups of people are prone to gallbladder problems?
| People who like high-fat diet |
| Excessive consumption of greasy food will cause the body to need to discharge more bile to help digestion, and repeated increase in bile discharge may cause stagnation and blockage, increasing the burden on the gallbladder and causing excessive bile to stimulate the gallbladder for a long time, which may cause chronic inflammation. Inflammation continues to aggravate the blockage of the gallbladder, leading to chronic cholecystitis or the formation of gallstones; and a high-fat, low-fiber diet will also increase the cholesterol saturation of bile, promote the formation of stones, and stones irritating the bile duct will lead to chronic cholecystitis, which aggravates each other. |
| Obese people |
| On the one hand, obese people tend to like greasy food, which leads to the above situation; on the other hand, obese people often have metabolic problems and are more prone to bile congestion, leading to cholecystitis or gallstones. |
| Women’s Group |
| The actual incidence shows that women are more susceptible to gallbladder diseases, which may be related to the fact that women’s hormone secretion is different from that of men, and they are more prone to endocrine disorders, fat accumulation and other problems. |
| People who sit for a long time and lack exercise |
| Long-term sitting and lack of exercise can easily lead to a decrease in the contractility of the gallbladder muscles, causing bile emptying disorders and excessive congestion in the gallbladder, which can easily cause gallbladder problems. |
| People with certain medical conditions |
| ① Diabetic patientsHigh blood sugar levels can induce bacterial growth. Repeated bacterial stimulation can easily affect the normal function of the gallbladder, causing bile to accumulate more easily, thereby causing gallbladder problems.② Patients with fatty liver/cirrhosisWhen an individual has problems with liver function, the liver’s ability to regulate blood will be inhibited, which in turn affects the secretion of bile, causing bile to accumulate in the gallbladder for a long time, thereby increasing the individual’s probability of developing gallbladder disease. |
| People with a family genetic tendency |
| People whose family has 2 or more cases of gallbladder disease (especially those who developed the disease before the age of 50) may have a family genetic tendency and need to pay more attention to gallbladder maintenance than the average person. |
| The elderly |
| Due to the decline in metabolic capacity and physical function, the elderly are more prone to stagnation in various parts of the body than young people, making them more susceptible to various stagnation diseases including gallbladder disease.[1] |
07
What are the common methods used by Western medicine to treat chronic cholecystitis/gallstones?
Chronic cholecystitis
For patients with chronic cholecystitis, Western medicine recommends individualized treatment according to whether there are symptoms and complications. For patients with obvious symptoms or increased, enlarged, or incarcerated gallstones or suspected malignant changes in the gallbladder, cholecystectomy is recommended. Common treatments include:
Medical treatement
① Oral medication for lithotripsy
Western medicine believes that patients with asymptomatic gallstones do not need treatment, but patients with symptoms who are not suitable for surgery and whose gallbladder function is normal as assessed by abdominal ultrasound and whose cholesterol stones are negative on X-ray examinations may consider oral litholytic treatment.
② Antispasmodic and analgesic
During acute attacks of biliary colic, fasting and effective analgesic treatment should be given. Commonly used drugs include atropine, scopolamine, pethidine, etc.
③ Relieve symptoms of biliary indigestion
Patients with chronic cholecystitis often experience indigestion symptoms. Commonly used Western medicines for early symptoms include compound azintamide or other pancreatic enzymes.
④ Anti-infective
Patients with chronic cholecystitis usually do not need to use antibiotics. However, when patients have underlying diseases, especially those with liver and kidney damage, antibiotics should be used reasonably.
Surgical treatment
Indications for surgery
▪ Patients with chronic cholecystitis who have pain that cannot be relieved or recurs despite medical treatment, affecting their daily life; patients whose gallbladder wall gradually thickens by more than 4 mm or thickens in the same part or are suspected of malignant transformation;
▪ Cholecystitis is accompanied by stones, which increase in size and number year by year or become impacted in the neck of the gallbladder, accompanied by gallbladder dysfunction or obstruction;
▪ Ceramic changes in the gallbladder wall;
▪ Surgical treatment should be considered when there is a gallbladder polyp with a diameter >1 cm.
Preventive cholecystectomy
Preventive cholecystectomy is suitable for high-risk groups who are prone to gallbladder cancer, patients who have received immune transplantation after organ transplantation, patients with rapid weight loss, and people whose “porcelain” gallbladder increases the risk of gallbladder cancer.
Gallstones
For asymptomatic gallstones, Western medicine recommends not to implement treatment for the time being, but only to improve lifestyle and have annual physical examinations and abdominal ultrasound examinations. The doctor will comprehensively evaluate whether surgical treatment is needed. In most cases, follow-up observations are conducted every six months, and preventive surgical resection is not required. For gallstones with symptoms and (or) complications, common Western medicine treatments include:
Medical treatement
Common Western medicines for the treatment of gallstones:
① Antispasmodic and analgesic
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, ketoprofen or indomethacin have analgesic effects on biliary colic. Anisodamine is generally used as an antispasmodic drug.
② Choleretic and anti-infective treatment
Dehydrocholic acid tablets or ursodeoxycholic acid tablets can be taken to promote bile excretion and control inflammation. However, these two drugs should not be used in cases of bile duct obstruction. For patients with mild acute cholecystitis, amoxicillin-clavulanic acid combined with metronidazole can be used for anti-infection treatment. For complex cholecystitis, such as acute cholangitis, accompanied by severe infection, broad-spectrum antibiotics are usually required.
Surgical treatment
Western medicine generally recommends early surgical treatment for patients with symptomatic cholelithiasis, because about 50% of patients will experience recurrence of biliary colic, and patients with recurrent gallstones are more likely to develop complications such as biliary pancreatitis, obstructive jaundice and cholangitis.
① Gallstone
Patients with symptomatic gallstones should receive surgical treatment as soon as possible, and Western medicine prefers minimally invasive laparoscopic cholecystectomy.
② Bile duct stones
For patients with bile duct stones, Western medicine prefers endoscopic retrograde pancreaticobiliary lithotomy and endoscopic sphincterotomy or laparoscopic bile duct exploration combined with cholecystectomy. If the stones cannot be completely removed during surgery, a T-tube can be left in place for drainage to relieve bile duct obstruction first, and then radical resection can be performed at an appropriate time.
Analysis of the effect of western medicine treatment
When the patient’s condition is mild, common drugs may be able to control the symptoms of the disease, but when the condition is severe, such drugs have limited effect on controlling the symptoms. And regardless of the severity of the disease, since such drugs only target the symptoms of the disease and do not touch the root cause of the disease – stasis, they are not curative.
As for surgical treatment, in addition to potential treatment risks such as infection, various common intraoperative injuries, and postoperative complications, surgery also has the risk of “stagnation” due to failure to touch the disease lesion. Therefore, there is a high risk of recurrence after surgery.
08
How does Traditional Chinese Medicine view the treatment of chronic gallbladder problems?
First, when should cholecystitis be treated?
Chinese medicine emphasizes prevention over cure. It is best to nip the disease in the bud. However, if the disease has already occurred, regardless of whether there are symptoms or not, intervention should be made as soon as possible to prevent further progression of the disease. Because when the disease develops symptoms, it often means that the condition is already quite serious. If treatment is started at this stage, the patient will often have to endure more physical and mental pain, and will also face a longer treatment period than with early intervention.
Secondly, how to treat cholecystitis specifically.
To cure any disease, you must find and treat the root cause of the disease. As mentioned above, the root cause of common gallbladder problems is stasis. So the key to achieving a complete cure, eliminating the symptoms of gallbladder problems while also eliminating the root cause, is to clear the stasis, and do it in a way that is holistic, focused on nourishing, and improving the patient’s physical functions.
09
How to effectively achieve gallbladder decongestion treatment?
Since the key to treating common chronic gallbladder diseases is to clear the stagnation, how should we clear the stagnation specifically and how can we achieve the comprehensive and thorough removal of stagnation with a holistic perspective as mentioned above?
First of all, maintaining good living habits is necessary and effective in preventing and removing stasis, but the effect is very limited. Especially for patients whose stasis has caused certain physical problems and symptoms, it is necessary to use external force to remove stasis.
In order to achieve a thorough and comprehensive gallbladder cleansing, the gallbladder function should be improved as well as the body’s immunity and disease resistance.
Based on the traditional medical wisdom of more than 2,000 years, and with the help of modern medical perspective, we can summarize several Chinese medicinal raw materials that are particularly outstanding in dispersing stagnation, promoting blood circulation, removing dampness, promoting urination, clearing heat, and replenishing the body:
Bee pollen, dandelion, Houttuynia cordata, purslane, poria, platycodon, peach kernel
Among them, bee pollen is known as an “all-round nutritional food”. The last six common plant raw materials are all items that have the same origin as medicine and food and are listed in Appendix 1 of the 《List of Items that Are Both Food and Medicines》 in the 《Notice on Further Standardizing the Management of Health Food Raw Materials》 published by the Ministry of Health. Suitable for daily use.
However, it is best for ordinary people not to make their own medicines. It is difficult for ordinary people to grasp the ratio of medicinal flavors, have no in-depth understanding of pharmacology, and it is difficult to distinguish the quality of medicinal materials. Moreover, the effects of medicinal materials are not purely additive, and it is difficult for ordinary people to know whether the combination of different raw materials will produce certain toxicity. Therefore, the formula and usage still require professional help.
For cholecystitis/gallstones, at different stages, the role of dredging is roughly:
【Phase 1】
Promote bile excretion and facilitate stone excretion
The effect of clearing stagnation in this stage is mainly reflected in promoting the normal excretion of bile, avoiding bile stasis and excessive concentration that stimulates the gallbladder, improving the gallbladder environment, thereby eliminating the various major symptoms caused by gallbladder problems, preventing the formation of stones; and facilitating the rapid downward discharge of already formed gallstones.
【Phase 2】
Stable elimination of inflammation and improvement of function
The dredging effect at this stage is mainly reflected in helping to continue to expel the remaining small amount of gallbladder/bile duct crystals and small stones, while further optimizing the internal environment, enhancing the body’s self-healing ability, and restoring the body’s functions, thereby stabilizing and completely eliminating gallbladder inflammation.
【Phase 3】
Prevent congestion and maintain a healthy state of smooth flow and vitality
The effect of dredging in this stage is mainly reflected in preventing the occurrence of stagnation and preventing the recurrence of gallbladder problems. At the same time, it improves the body’s circulatory and metabolic capacity and strengthens the immune system, thereby preventing the occurrence of various stagnation diseases and keeping the body in a healthy state of smoothness and vitality.
10
How do patients with chronic gallbladder disease take care of themselves on a daily basis?
| Light diet |
| Patients with gallbladder disease should eat small and frequent meals, eat a light diet, eat a moderate amount of foods rich in protein and fiber, as well as fresh fruits and vegetables, supplement with sufficient vitamins and minerals, ensure a reasonable supply of carbohydrates, and especially avoid eating fried foods, fatty meat, cream and other foods with high fat content. A light diet can avoid direct stimulation of the gallbladder by a bad diet and can also help patients control their weight（Obesity increases risk of gallbladder disease） |
| Reasonable exercise |
| Regular exercise can increase the utilization and metabolism of fat, prevent its accumulation and affect the metabolism and excretion of bile; reasonable exercise can also help improve the body’s overall metabolic function and alleviate the occurrence and aggravation of congestion in various places. |
| Get rid of bad habits |
| Patients with gallbladder diseases should avoid smoking as much as possible. Tobacco contains a large amount of harmful substances such as nicotine, carbon monoxide, tar and nitrosamines, which may increase the cholesterol content in the serum, stimulate the gallbladder wall mucosa to increase secretion, and promote the formation of cholesterol crystals in bile, leading to gallstones in patients; The damage caused by drinking to the gallbladder is mainly caused by the liver, because alcohol is mainly metabolized by the liver. Long-term and large-scale drinking will damage liver cells. Liver cells cannot metabolize normally, which can lead to abnormal bile secretion and various diseases of the gallbladder, the so-called “liver and gallbladder are in harmony”; Staying up late and having big mood swings are also common factors that affect the body’s metabolism and aggravate stagnation, and patients should try to avoid them. |
| Adhere to daily routine to clear stagnation |
| Since stasis occurs constantly and gradually intensifies during normal metabolic processes and the aging process, especially for patients with gallbladder diseases and people who are prone to gallbladder diseases, clearing stasis as a daily health regimen can effectively prevent the occurrence, aggravation or recurrence of chronic gallbladder diseases and various stasis-related diseases. |
Knowledge Development
- Problems that may be caused by stasis
When the stagnation is mild, it can lead to sub-health problems such as fear of cold, cold hands and feet, sexual dysfunction, chloasma, acne, hair loss, low back pain, lower abdominal pain, pelvic effusion, joint effusion, etc.; if the stagnation becomes more severe, it may cause various chronic diseases such as prostate disease, urinary system disease, gynecological diseases, gout, cysts, stones, etc.
