Trip Answers

Question answered:30/08/07 Warning! this question is over two years old.

Although we found numerous studies examining diet as a risk factor for the development of gallstones, we found little information on diet therapy to treat patients with gallstones.

 

An e-Medicine article on cholethiasis states:

 

“Little evidence suggests that dietary composition affects the natural history of gallstone disease in humans. Obese patients who undertake aggressive weight loss programs or undergo bariatric surgery are at risk to develop gallstones; short-term prophylaxis with ursodeoxycholic acid should be considered.” [1]

 

A patient information leaflet on gallstones notes:

 

“Changes in diet have no effect on gallstones, but it is advisable to eat a well balanced healthy diet, and to control your weight.” [2]

 

However, GPNotebook states in its entry on cholecystitis:

 

“Chronic cholecystitis requires a different tact. A low-fat diet may be the only requirement in a rarely symptomatic subject.” [3]

 

In a small, non-randomised study dating from 1984, Mogadam examined gallbladder dynamics in response to various meals in order to establish if dietary fat restriction is necessary in the management of gallstones and reported:

 

“To assess the gallbladder dynamics in response to various meals, we studied 15 subjects (ages 21-54), each on 4 separate days. After an overnight fast, each subject was given, at random, either a breakfast containing greater than 30 g fat, less than 15 g fat, totally free of fat, or an infusion of C-terminal octapeptide of cholecystokinin. Gallbladder ejections at regular time intervals were measured using real time ultrasonography and the sum of cylinders technic corrected for the gallbladder shape. Considerable variability in the gallbladder dynamics and time response was noted with all the stimuli…We conclude that the gallbladder dynamics in response to various meals are independent of a meal's fat content. Since the passage of gallstones into the cystic or common duct (biliary colic) is a random event unrelated to the type of food, fat-restricted diets offer no significant therapeutic advantage in the management of the large population with asymptomatic gallstones.” [4]

 

Concerning the spontaneous remission of symptoms associated with gallstones, we located just one study on this topic. The Medine abstract of this article reads:

 

“BACKGROUND: Little is known about the spontaneous passage of bile duct stones. The aim of this study was to determine the rate of spontaneous stone passage and relate it to the clinical presentation of the bile duct stone. PATIENTS AND METHODS: Prospectively collected data were studied on a total of 1000 consecutive patients undergoing laparoscopic cholecystectomy with or without laparoscopic common duct exploration. Comparisons were made between 142 patients with common bile duct stones (CBDS), 468 patients who had no previous or current evidence of duct stones, and 390 patients who had good evidence of previous duct stones but none at the time of cholecystectomy. The evidence used for previous duct stones included a good history of jaundice or pancreatitis. In patients with biliary colic or cholecystitis, abnormal pre-operative liver function tests and/or a dilated common bile duct were taken as evidence of bile duct stones.

 

RESULTS: Of the 1000 patients studied, 532 had evidence of stones in the common bile duct at some time prior to cholecystectomy. At the time of operation, only 142 patients had bile duct stones. By implication, 80%, 84%, 93% and 55% of patients presenting with pancreatitis, colic, cholecystitis and jaundice (73% overall) had passed their bile duct stones spontaneously. All 4 patients with cholangitis had duct stones at the time of operation. CONCLUSIONS: It is likely that most bile duct stones (3 in 4) pass spontaneously, especially after pancreatitis, biliary colic and cholecystitis but less commonly after jaundice. Cholangitis appears to be always associated with the presence of duct stones at the time of operation.” [5]

 

References
1. Heuman D. Cholethiasis. E-Medicine. August 2006. (http://www.emedicine.com/med/topic836.htm)
2. NHS Direct. Gallstones. http://www.cks.library.nhs.uk/patient_information_leaflet/Gallstones
3. http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1898971114&linkID=16057&cook=yes
4. Mogadam M, Albarelli J, Ahmed SW et al. Gallbladder dynamics in response to various meals: is dietary fat restriction necessary in the management of gallstones? Am J Gastroenterol. 1984 Oct;79(10):745-7. (http://www.hubmed.org/display.cgi?uids=6486112).
5. Tranter SE and Thompson MH. Spontaneous passage of bile duct stones: frequency of occurrence and relation to clinical presentation. Ann R Coll Surg Engl. 2003 May;85(3):174-7. (http://www.hubmed.org/display.cgi?uids=12831489)

---

DISCLAIMER: TRIPanswers is a collection of clinical questions and answers.  Each provider will have their own methodology in answering questions and these are likely not to be as rigorous as systematic review.  If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. TRIPanswers and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document.  Also, ensure you have read the terms and conditions for using the site.