Who is at risk for gallstones?
Risk for cholesterol gallstones.
There is no relationship between cholesterol in the blood and cholesterol gallstones. Individuals with elevated blood cholesterol do not have an increased prevalence of cholesterol gallstones. A common misconception is that diet is responsible for the development of cholesterol gallstones, however, it isn't. The risk factors for developing cholesterol gallstones include:
- Gender. Gallstones occur more commonly in women than men.
- Age. Gallstone prevalence increases with age.
- Obesity. Obese individuals are more likely to form gallstones than thin individuals.
- Pregnancy. Pregnancy increases the risk for cholesterol gallstones because during pregnancy, bile contains more cholesterol, and the gallbladder does not contract normally.
- Birth control pills and hormone therapy The increased levels of hormones caused by either treatment mimics pregnancy.
- Rapid weight loss. Rapid weight loss by whatever means, very low calorie diets or obesity surgery, causes cholesterol gallstones in up to 50% of individuals. Many of the gallstones will disappear after the weight is lost, but many do not. Moreover, until they are gone, they may cause problems.
- Crohn's disease. Individuals with Crohn's disease of the terminal ileum are more likely to develop gallstones. Gallstones form because patients with Crohn's disease lack enough bile acids to solubilize the cholesterol in bile. Normally, bile acids that enter the small intestine from the liver and gallbladder are absorbed back into the body in the terminal ileum and are secreted again by the liver into bile. In other words, the bile acids recycle. In Crohn's disease, the terminal ileum is diseased. Bile acids are not absorbed normally, the body becomes depleted of bile acids, and less bile acids are secreted in bile. As a result there is not enough bile acids to keep cholesterol dissolved in bile, resulting in gallstone formation.
- Increased blood triglycerides. Gallstones occur more frequently in individuals with elevated blood triglyceride levels.
Risk for pigment gallstones
Black pigment gallstones form whenever an increased load of bilirubin reaches the liver. This occurs when there is increased destruction of red blood cells, as in diseases such as sickle cell disease and thalassemia. Black pigment gallstones also are more common in patients with cirrhosis of the liver. Brown pigment gallstones form when there is stasis of bile (decreased flow), for example, when there are narrow or obstructed bile ducts.