Experiencing a gallstone attack, known as biliary colic, can be intensely painful and frightening. This sudden, sharp pain in the upper abdomen, often occurring after eating a fatty meal, indicates that a small, hardened deposit has formed in the gallbladder and is blocking the bile duct. Beyond the acute pain, living with symptomatic gallstones can lead to anxiety about when the next attack will strike, severely limiting dietary choices and daily routines.

Treatment is essential to relieve the severe pain, prevent further attacks, and avoid potentially life-threatening complications, such as gallbladder infection (cholecystitis), bile duct blockage, or pancreatitis. Symptoms and treatment needs vary greatly; some people have gallstones that cause no issues (asymptomatic), while others experience frequent, debilitating pain. For symptomatic cases, medication plays a role in managing acute pain or, in very specific instances, attempting dissolution.

Overview of treatment options for Gallstones

For symptomatic gallstones (those causing pain or complications), surgical removal of the gallbladder (cholecystectomy) is the standard and definitive treatment. However, medications are utilized in several key ways.

The goals of drug treatment are two-fold: first, to provide immediate relief during a painful attack, and second, to attempt to dissolve certain types of gallstones in patients who cannot undergo surgery due to other health factors. Medication that actively targets the gallstones aims to break down the deposits, offering a non-surgical alternative, although this approach is limited to specific types of stones and requires a very long commitment. Asymptomatic gallstones usually require no active medication but are monitored closely.

Medications used for Gallstones

The primary drug class used to treat the underlying cause of gallstones is Bile Acid Dissolution Agents. The most commonly used medication in this group is ursodeoxycholic acid (ursodiol). This medication is only effective against small, non-calcified gallstones made predominantly of cholesterol. It is generally not effective for pigment stones or larger deposits.

For patients experiencing acute, severe pain (biliary colic), Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are often administered in a clinical setting. Medications like ketorolac can help reduce inflammation and cramping during an attack. If a gallstone leads to an infection of the gallbladder (acute cholecystitis), antibiotics are necessary to control the bacterial spread. These may include broad-spectrum antibiotics such as cephalosporins or ampicillin, depending on the severity of the infection (National Institute of Diabetes and Digestive and Kidney Diseases, 2023).

How these medications work

Bile acid dissolution agents work by altering the chemical composition of the bile produced by the liver. Gallstones form when there is an excess of cholesterol in the bile. Ursodiol works by reducing the amount of cholesterol secreted into the bile, thereby making the bile less concentrated and helping the liquid gradually dissolve the stones over time. Clinical experience suggests this process is very slow, often requiring six months to two years of continuous treatment, and there is a high risk that the stones may return after treatment stops.

NSAIDs help relieve the intense crampy pain of biliary colic by blocking the action of prostaglandins, chemicals that promote pain and inflammation. This also helps relax the smooth muscle that is contracting around the blocked duct. Antibiotics, conversely, do not affect the stone itself; they specifically target the bacteria that have colonized the gallbladder due to the blockage.

Side effects and safety considerations

Bile acid dissolution agents are generally well-tolerated, but common side effects include mild stomach upset, nausea, and diarrhea. Because gallstones are often associated with the liver, it is important to avoid alcohol and inform your physician about all other medications, as dissolution agents require careful monitoring.

NSAIDs carry a risk of stomach irritation and bleeding, particularly with frequent use. Patients should seek immediate medical attention if they experience severe, worsening abdominal pain, persistent vomiting, high fever, or jaundice (yellowing of the skin and eyes), as these symptoms suggest a potentially life-threatening obstruction or infection (Mayo Clinic, 2024).

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.

References

1. Mayo Clinic. https://www.mayoclinic.org
2. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov
3. Centers for Disease Control and Prevention. https://www.cdc.gov
4. Food and Drug Administration. https://www.fda.gov