Gallstones and Gallbladder Disease - Symptoms

Highlights	Prevention	Managing Common Bile Duct Stones
Introduction	Diagnosis	Resources
Symptoms	Treatment	References
Prognosis	Surgery
Risk Factors	Lithotripsy and Dissolution Therapies

Symptoms

About 90% of gallstones provoke no symptoms at all. If they do occur, the chance of developing pain is about 2% per year for the first ten years after stone formation, after which the chance for developing symptoms declines. On average, symptoms take about eight years to develop. The reason for the decline in incidence after 10 years is not known, although some doctors suggest that "younger," smaller stones may be more likely to cause symptoms than larger ones.

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Biliary Pain

The mildest and most common symptom of gallbladder disease is intermittent pain called biliary colic, which occurs either in the mid- or the right portion of the upper abdomen. A typical attack has several features:

The primary symptom is typically a steady gripping or gnawing pain in the upper right abdomen near the rib cage, which can be quite severe and can radiate to the upper back. Some patients with biliary colic experience the pain behind the breast bone.
Nausea or vomiting may occur.
Changes in position, over-the-counter pain relievers, and passage of gas do not relieve the symptoms.
Biliary colic typically disappears after one to several hours. If it persists beyond this point then acute cholecystitis or more serious conditions may be present.
The episodes typically occur at the same time of day but less frequently than once a week. Large or fatty meals can precipitate the pain, but it usually occurs several hours after eating and often wakes the patient during the night.
Recurrence is common but attacks can be years apart. In one study, for example, 30% of people who had had one or two attacks experienced no further biliary pain over the next ten years.

Digestive complaints such as belching, feeling unduly full after meals, bloating, heartburn (burning feeling behind the breast bone), or regurgitation (acid back-up in the food pipe) are not likely to be caused by gallbladder disease. Conditions that may cause these symptoms include peptic ulcer, gastroesophageal reflux disease, or indigestion of unknown cause. [For more information, see In-DepthReports #19 Peptic Ulcers or #85 Gastroesophageal Reflux Disease.]

Symptoms of Gallbladder Inflammation (Acute Cholecystitis)

Between 1% and 3% of people with symptomatic gallstones develop inflammation in the gallbladder (acute cholecystitis), which occurs when stones or sludge obstruct the duct. The symptoms are similar to those of biliary colic but are more persistent and severe. They include the following:

Pain in the upper right abdomen is severe and constant and can last for days. Pain frequently increases when drawing a breath.
Pain also may radiate to the back or occur under the shoulder blades, behind the breast bone, or on the left side.
About a third of patients have fever and chills.
Nausea and vomiting may occur.