The Observer (Kampala)

4 December 2012

Uganda: Have Incessant Stomach Pain? It Could Be Gallstones

A regulated diet may help prevent the condition The condition, gallstones -"hard, pebble-like deposits that form inside the gallbladder"- is one of those you rarely hear about. Think about it, how many people have you heard about that have been diagnosed with gallstones in the past five years?

I've heard about two and both diagnoses, which I heard about, were made late this year. Yet, Dr Vincent Karuhanga says that more and more people are being diagnosed with gallstones.

"We are seeing them even in children," he says. Gallstones are likely to occur in older individuals with those over 40 more susceptible.

Karuhanga attributes the increase in occurrence of gallstones to poor diet. "Gallstones occur as a result of cholesterol in bile and so you find that people who are feeding poorly have high cholesterol levels which predispose them to gallstones".

Gallstones may also occur as a result of destruction of red blood cells, which results into too much bilirubin in bile, forming stones. Cholesterol stones are the most common type of gallstones.

Hard to diagnose:

According to www.ncbi.nlm.nih.gov, gallstones are often found accidentally, during routine medical examinations. This is because they rarely trigger symptoms. However, for Ruth who suffered from excruciating stomach pain for four years before getting a gallstone diagnosis, the symptoms were there alright.

Because her symptoms were hard to pin down -one of the symptoms of gallstones is pain in the mid to upper right side of the stomach- Ruth didn't get a diagnosis till so many years later.

"I had pain all over my stomach," Ruth says. She was x-rayed, did an ultra-sound scan and an endoscopy and didn't get the right diagnosis. She was diagnosed with ulcers and a bacterial infection treatment of which didn't result in curing.

"I had given up. I knew I would die with my stomach [pain]," Ruth says. Ruth's pain was horrendous. "Every single night, I would wake up at 3am, in pain," Ruth says.

She also recalls attending a work meeting where the meeting's minutes passed her by because her pain was too much she couldn't pay attention. Gallstones are best diagnosed using an ultrasound scan as x-rays may miss them.

Symptoms:

Gallstones are sometimes painful and it is important that they are diagnosed. Your physician needs to look out for the symptoms. Karuhanga says that the first symptom that usually precedes a diagnosis of gallstones is gas in the stomach.

Other symptoms include fever, yellowing of skin and eye whites (jaundice), clay-coloured stool, gas in the stomach and nausea and vomiting. Sometimes, gallstones trigger no symptoms and where they don't, one may not require treatment.

Treatment:

Gallstones may be as big as a golf ball or as small as a grain of sand. Sometimes, a collection of small stones may form. Where symptoms occur, treatment is needed immediately or in a short period of time.

Treatment available in Uganda includes drugs that can dissolve the stones, though this method may not work in some people or it may take too long to work. According to information on ncbi.nlm.nih.gov, treatment using drugs could result in resurgence of the gallstones within a short period of time.

Gallstones may also be crushed using ultrasound (ursodiol) although as the stones are being excreted, a lot of pain is likely to be experienced. Surgery is the other treatment option.

In Uganda, laparoscopic cholecystectomy, which uses smaller surgical cuts and results in shorter stay at hospital, is available. It is more expensive than the open abdominal surgery though. With surgery, the gallbladder is removed.

Gallstones in the bile channels may re-occur after surgery, although this is rare. The key to preventing reoccurrence of gallstones is to minimize factors that put one at risk of gallstones. Note that treatment of gallstones using olive oil and lemon juice does not result in a cure.

Prevention:

One may prevent gallstones by eating a diet low in fat and cholesterol and foods rich in fibre (these lower bile cholesterol too), according to Karuhanga. Avoid rapid weight loss, which results in fat being deposited in the gall bladder thus predisposing one to gallstones.

Maintaining healthy weight minimises risk. However, in most instances, gallstones are not preventable.

Risk factors:

What predisposes one to gallstones?

Age - if you are above 40, you are at risk.

Gender- Women are more at risk. Pregnancy, which may prevent the proper emptying of the bladder, also puts one at risk. Use of hormonally based contraceptives also puts one at risk.

Genetics

Disease conditions like diabetes, liver cirrhosis, billiary tract infections, sickle cell anaemia and haemolytic anaemia.

Solid organ or bone marrow transplant.

Rapid weight loss from low-calorie diet.

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