Bloating and Pain: The Impact of Gallstones on Digestive Health

Bloating, stomach pain, and gallstones?

Doctor, hello.
I have been experiencing bloating after meals for many years, but I could quickly relieve it by taking some antacids or simethicone.
However, in the past 1-2 years, the frequency of bloating has increased, and sometimes normal eating causes bloating that lasts longer.
The antacids I used to take seem to be ineffective now.
Therefore, I underwent an endoscopy last December, which revealed mild ulcers and gastroesophageal reflux disease (GERD).

Starting from August 2nd of this year, around 1-2 AM, I began experiencing a dull, bloated pain below my sternum, accompanied by cold sweats.
Pressing on the area provided some relief, and there was also slight pain when pressing on the lower right side to the waist.
After taking some over-the-counter antacids at home, I experienced relief about an hour later after burping and passing gas.
The next morning, there were no unusual symptoms.
This same situation has occurred five times to date: on August 2, August 5, September 19, September 23, and November 3.
Four of these five episodes occurred after eating out, and the first four episodes happened between 1-2 AM.
I have a history of gallstones for about 15 years, with multiple stones, and I have been undergoing regular monitoring.
In May of last year, during a health check-up, the largest stone measured 0.43 cm, with no significant changes compared to previous assessments.
Since I have never experienced stomach pain before, I have been living with it without concern.
My bowel movements remain normal, occurring 1-2 times daily.
After the stomach pain began in August, I started eating smaller, more frequent meals in September, limiting spicy and gas-producing foods and fruits, and I have increased my exercise routine.
However, the intermittent stomach pain continues to cause me anxiety.
In October, I had blood tests and an ultrasound of my liver and gallbladder, which showed no abnormalities other than the gallstones.
I usually maintain a regular eating schedule with three meals a day and rarely overeat.
Aside from bloating and gallstones, I have never experienced stomach pain before.

Could gallstones cause bloating and stomach pain? If so, is it necessary to remove the gallbladder, or can it be managed with exercise and diet? If not removed, what are the potential risks? Thank you for your valuable time, and I look forward to your response.

Liu Xiaojie, 50~59 year old female. Ask Date: 2016/11/22

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, if you experience discomfort after meals, you may consider gallbladder surgery, although it may not necessarily be effective.
It would be advisable to discuss this further with a gastroenterologist.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2016/11/22

More Info

Gallstones, or cholelithiasis, can significantly impact digestive health, leading to a variety of symptoms, including bloating and abdominal pain. Your history of gallstones, along with the recent episodes of discomfort, suggests that there may be a connection between your gallstones and the gastrointestinal symptoms you are experiencing.

Gallstones can cause symptoms when they obstruct the bile ducts, leading to a condition known as biliary colic. This obstruction can result in pain in the upper right abdomen, which may radiate to the back or shoulder. The pain often occurs after meals, particularly those high in fat, as the gallbladder contracts to release bile for digestion. In your case, the episodes of bloating and discomfort after eating, especially after external meals, may indicate that your gallstones are contributing to these symptoms.

The presence of a mild ulcer and gastroesophageal reflux disease (GERD) complicates the picture. Both conditions can cause similar symptoms, such as bloating and abdominal pain. However, the timing of your symptoms, particularly the late-night episodes of pain and discomfort, raises concern about a possible gallbladder-related issue. The fact that these episodes have occurred after eating out suggests that certain foods may exacerbate your symptoms, possibly due to the gallstones' interference with normal digestion.

Regarding the management of gallstones, the decision to undergo surgery, specifically cholecystectomy (gallbladder removal), depends on several factors. If gallstones are asymptomatic, many healthcare providers may recommend a watchful waiting approach, as the risk of complications is relatively low. However, given your history of symptoms and the recent increase in frequency and severity, surgical intervention may be warranted.

There are several risks associated with not removing the gallbladder when symptomatic gallstones are present. These include:
1. Acute Cholecystitis: This is an inflammation of the gallbladder that can occur if a gallstone obstructs the cystic duct. It can lead to severe pain, fever, and potentially serious complications if not treated promptly.

2. Pancreatitis: Gallstones can also block the pancreatic duct, leading to inflammation of the pancreas, which can be a life-threatening condition.

3. Biliary Colic: Recurrent episodes of pain can significantly affect your quality of life and may lead to chronic discomfort.

4. Risk of Complications: The longer gallstones are left untreated, the higher the risk of developing complications that may require emergency surgery.

In terms of managing your symptoms through lifestyle changes, while diet and exercise can help alleviate some discomfort, they may not be sufficient to resolve the underlying issue of gallstones. A low-fat diet, smaller meals, and regular exercise can help reduce symptoms, but they do not eliminate the risk of complications associated with gallstones.

In conclusion, while it is possible to manage symptoms through dietary changes and lifestyle modifications, the presence of gallstones, especially with your history of symptoms, suggests that surgical intervention may be the most effective long-term solution. It is crucial to have a detailed discussion with your healthcare provider about your symptoms, the risks of surgery versus the risks of leaving the gallstones untreated, and to explore the best options tailored to your specific situation.

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