Gallstone disease and Sphincter of Oddi Dysfunction (SOD)
Causes and risk factors
Biliary stones are a widespread disease in socioeconomically developed countries. In Italy it is estimated that about 3-4 million people are carriers of stones or have already undergone surgery to remove the gallbladder. The presence of bile oversaturated with cholesterol (lithogenic bile) causes this substance to precipitate creating bile sludge and microcrystals inside the gallbladder, which over time tend to calcify with the formation of stones. This occurs more easily if the gallbladder shows disturbances in its contractile activity. Rapid weight loss as a result of excessive weight loss diets can be a precipitating factor.
Which are the symptoms?
Approximately two-thirds of stone-bearing individuals have no symptoms or complaints. Bloating, poor digestion, stomach weight, belching, sometimes present in these people, are not usually related to stones and often persist or even worsen after cholecystectomy surgery. Biliary colic is the most common symptom: it is manifested by sudden onset pain, often nocturnal, rather intense, cramp-like localized in the upper abdomen, radiating to the right side and back. The indication for surgical treatment arises precisely when biliary colic appears. If the stones migrate into the choledoco, obstructive jaundice (yellow coloration of the skin), acute cholangitis, acute pancreatitis can be determined.
How is it diagnosed?
Diagnosis is made by ultrasonography or computerized axial tomography (CT). In cases of calculosis that are difficult to diagnose (e.g. small stones in the choledochus) sophisticated imaging methods (cholangio-magnetic resonance imaging) or transpapillary retrograde cholangiography (ERCP) are used.
How is it treated?
The preferred treatment is cholecystectomy (the removal of the gallbladder). In the vast majority of cases, the procedure is performed laparoscopically, making only three small cuts in the patient's abdomen, with a very short hospital stay. When stones migrate from the gallbladder to the choledoco, obstructing the passage of bile into the intestine, their removal is implemented endoscopically by performing a papillosphinterotomy during ERCP. Normally, the two procedures in this case are performed in a single operating session. Techniques such as extracorporeal lithotripsy (EPL) and interventional radiology are also available, allowing the removal of very large stones or those located inside the liver.