Crohn’s Complications: What to Know About Gallstones

Digestive pain is an unfortunate fact of life for those with Crohn’s disease. In addition to the discomfort of diarrhea, abdominal cramps, and other Crohn’s complications, you’re also at increased risk for painful gallstones. In fact, a study published in the International Journal of Environmental Research and Public Health found that people with Crohn’s disease have more than a twofold risk of developing gallstones than the general population.

The gallbladder is a small, pear-shaped organ located right below the liver. Gallstones form in the gallbladder when bile, a liquid made in the liver and stored in the gallbladder to help the body digest fats, hardens. These stones can be as small as a grain of sand, often called sludge, or as large as a golf ball. The liver and gallbladder are closely interconnected with the intestines, which are often inflamed from Crohn’s.

“Classically, Crohn’s will target the last portion of the small intestine known as the terminal ileum,” says Nour A. Parsa, MD, a gastroenterologist at Loma Linda University Health in California. “This is where bile acids, which are made in the liver, are primarily absorbed.”

During normal bilirubin metabolism, bile salts break up fat, and bilirubin gives bile and stool their yellowish brown color. If your bile contains too many bile salts, bilirubin, or cholesterol, it can harden into gallstones. If your Crohn’s affects the terminal ileum, the inflamed, diseased ileum fails to absorb bile salts.

“When bile salts and bile acids are not effectively reabsorbed, binding of cholesterol can be affected and lead to cholesterol gallstone formation,” says Suneeta Krishnareddy, MD, a gastroenterologist at Columbia University Irving Medical Center in New York City.

Other risk factors for gallstone formation in patients with Crohn’s disease include a history of small bowel surgical resection, which increases the risk of malabsorption, parenteral nutrition requirements, NSAID use, and altered gallbladder motility, Dr. Parsa says.

Symptoms of Gallstones

The majority of the gallstones are asymptomatic, notes Seifeldin Hakim, MD, a gastroenterologist with Memorial Hermann in Houston. “Many patients will have gallstones, and they do not even know it,” he says.

But gallstones cause discomfort when they block bile from entering the bile ducts. According to the Mayo Clinic, symptoms of blocked bile ducts, also called a “gallbladder attack,” include:

• Pain in the back between the shoulder blades
• Steady pain in the upper right quadrant of the abdomen that comes on suddenly and lasts from 30 minutes to several hours
• Pain under the right shoulder
• Nausea or vomiting

If you experience any of these symptoms, be sure to notify your doctor.

If you develop more severe symptoms — such as prolonged pain that lasts a few hours, a fever, clay-colored stools, nausea and vomiting, or yellowing of your skin or the whites of your eyes — seek medical attention right away.

Asymptomatic gallstone disease usually does not require any treatment, Parsa says, but when symptoms appear, intervention is usually necessary. The first treatment option for symptomatic gallstones may be gallbladder surgery; other options may include dissolution therapy, such as using shock waves to break up the stones, or medication that dissolves the stones.

Preventing Gallstones When You Have Crohn’s

“Gallstone disease is often a result of uncontrolled Crohn’s disease,” Parsa says. “Appropriate treatment (often with biologic therapy) and lifestyle measures, such as maintaining a healthy weight and keeping physically active, are the best ways to prevent gallstone formation.”

Managing your Crohn’s may also reduce the likelihood of surgical intestinal resection, which increases the risk of gallstones.

Beyond controlling Crohn’s and trying to avoid surgery, preventing gallstones when you have Crohn’s disease involves the same measures as preventing gallstones for everyone.

According to Harvard Health Publishing, these include:

• Maintain a healthy weight.
• Exercise regularly, at least 30 minutes a day, five days a week.
• Eat healthful monounsaturated fats instead of saturated fats.
• Limit sugary sweets and other sources of added sugar in your diet, as well as refined carbohydrates.
• Limit caffeine and alcohol consumption.
• Be aware that certain medications can increase risk for gallstones, such as some cholesterol-lowering drugs and hormone replacement medicines.

When Gallbladder Surgery Is Necessary With Crohn’s

The mere presence of gallstones doesn’t mean surgery to remove the gallbladder is necessary, notes Martin Luchtefeld, MD, a colorectal surgeon with Spectrum Health Medical Group in Grand Rapids, Michigan. “Reasons for removing the gallbladder include repeated episodes of cholecystitis [inflammation or infection of the gallbladder] or complications from gallstones, such as pancreatitis or bile duct stones,” he says.

Although you can expect gallbladder surgery to ease the pain of gallstones, Dr. Luchtefeld says, it may bring on an unpleasant and familiar symptom: diarrhea.

“The gallbladder normally stores bile produced by the liver until the time of a meal,” he explains. Eating food, especially fatty food, stimulates the gallbladder to release bile into the GI tract via the duodenum (the very first part of the small bowel, just after the stomach). “Once the gallbladder and its storage mechanism are removed, the bile is released continuously into the GI tract," he says. "So if bile is in the GI tract without food, it can be very irritating to the bowel and cause diarrhea."

If you need gallbladder surgery, Luchtefeld recommends finding a surgeon who works with people with Crohn’s on a regular basis.