The risks of developing symptoms or complications from gallstones in patients who have no symptoms is on the order of 20% over 20 years. Thus, patients who are older than 40 years of age and have no other indications for gallbladder treatment can be observed. Although there is a risk of having an attack at an inopportune time or developing one of the complications, this is small. However, patients with symptoms or no symptoms in the above mentioned groups should consider treatment.
Actigall (Ursodiol) is the primary drug used to dissolve gallstones. It is a naturally-occurring bile acid. This drug has almost no side effects but can rarely lead to increases in cholesterol or diarrhea. This is in marked contrast to other drugs which have been used in the past. These older drugs have been associated with severe diarrhea and abnormalities in liver function.
Actigall is taken two to three times per day and costs about $2.00 per pill. The drug works only in patients who have cholesterol or primarily cholesterol stones (80%). This can be determined by taking an x-ray of the abdomen. The stones are not visible on x-ray if they are cholesterol but are visible if they contain calcium bilirubinate (20%). Patients with cholesterol gallstones who take Actigall for two years have a 20% chance of having their gallstones dissolved. These patients need to continue taking Actigall once per day after the stones dissolve since their gallbladder remains diseased and there is a 30 to 50% chance of recurrence of gallstones in 3 to 5 years without further treatment. While you are on Actigall you will need to get blood tests every 3 months to make sure there are no problems with the treatment.
Lithotripsy, or shock wave dissolution of gallstones, is a new technique that uses a highly focused sound wave to break the stones up into tiny particles that can then pass through the cystic duct into the common duct and out into the intestine.