Doctors advise on World Digestive Health Day

Obesity has almost tripled since 1975 and it kills more people than being underweight. Overweight and obesity are defined as an excessive or abnormal accumulation of fat which can lead to many potentially serious diseases. According to studies, more than 1.9 billion are overweight and 650 million are obese worldwide.

Due to a sedentary lifestyle and high consumption of fast food and processed foods, people face a high risk of obesity and its negative consequences. Over 135 million people are affected by obesity in India alone. These statistics become even more alarming as the second wave of COVID-19 has sparked a new battle for India.

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According to the Centers for Disease Control and Prevention, obesity can triple the risk of hospitalization from COVID-19 infection, is linked to a weakened immune system and decreases lung capacity. Obese people also have an increased amount of cholesterol in their bile, which increases the risk of gallstones.

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On this World Digestive Health Day, let’s raise awareness about obesity and its impact on the development of co-morbidities, including gallstones.

Understanding gallstones in the gallbladder

Developed in the gallbladder, gallstones are hardened deposits of digestive fluid. To aid digestion, the gallbladder holds and releases a fluid made in the liver called bile.

Gallstones are solid masses that come from bile precipitates. There are 2 types of gallstones. 1. Cholesterol and 2. Pigment. Cholesterol stones, mainly found in women and obese people, are associated with bile supersaturated with cholesterol. They account for 80% of gallstones and are more often involved in obstruction and inflammation.

Gallstones are formed when bile hardens into lumps of solid matter. Gallstones block the bile duct causing pain that requires urgent medical intervention.

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Gallbladder problems cause pain in the right side or middle of the upper abdomen, back, and tip of the right scapula and can get worse after a heavy meal. Other symptoms include vomiting, nausea, chills, and fever.

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Factors that can increase the risk of gallstones include being female, 40 years of age or older, overweight or obese, sedentary lifestyle, pregnancy, high fat diet, high cholesterol diet, low diet fiber, a family history of gallstones, diabetes, certain blood disorders, such as sickle cell anemia or leukemia, liver disease and taking medicines containing estrogen.

Treat gallstones with advanced technologies

When one experiences the symptoms and signs of gallstones, it is essential to see the doctor. The doctor may recommend tests used to diagnose gallstones, including blood tests and imaging such as abdominal ultrasound or endoscopic ultrasound.

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Initially, medical management was attempted with little benefit. Attempts to dissolve the gallstone with ursodeoxycholic acid or direct instillation of ether into the gallbladder have been tried. But the recurrence of gallstones after stopping treatment is one of the main drawbacks.

Currently, gallbladder removal is the treatment of choice for symptomatic gallstone disease. However, patients with gallstones with stones blocking the bile duct can be treated with endoscopic treatment.

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Endoscopic retrograde cholangiopancreatography (ERCP) is a technique in which an endoscope is passed through the second part of the duodenum. Using a guide wire, the bile duct is cannulated and the stone is removed using a stone collection balloon or basket. It is simple, cost effective and can be done as a day care procedure.

Patients with gallstones larger than 2 cm or more required surgery. As medical science has evolved over the years, we now have improved instruments such as cholangioscopy that eliminate the need for surgery.

Direct visualization of the bile ducts during the procedure allows better control of the instruments used to remove stones and laser lithotripsy can be performed to fragment stones and remove them easily. Today, day stone carving is not a contraindication to ERCP. Cholangioscopy can also help differentiate between malignant and benign masses.

Weighing the Cost of Obesity: Better Gallstone Management
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Today, as scientific advances and minimally invasive procedures bring relief to millions of patients, let’s not forget that adopting a healthy lifestyle can go a long way in managing problems such as stones. gallstones. The risk of gallstones can be reduced if they don’t skip meals, lose weight slowly, eat more foods high in fiber, and maintain a healthy weight.

About the Authors: Dr Vinoth Kumar, Senior Consultant and Clinical Manager at GEM Hospital Chennai and Dr Nivesh Seehra, Consultant Physician and Gastroenterologist at Siddhanta Red Cross Super Specialist Hospital, Bhopal. The opinion expressed here is solely that of the authors.


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