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Consultant Laparoscopic Colorectal and General Surgeon

Gallstones and cholesterol – what’s the link?

Most gallstones are are made up of cholesterol. It’s less common for stones to contain pigment molecules and some are formed from a mixture of cholesterol and pigment.

Is there any way of finding out what type of gallstones someone has without removing them?

Mr Jonathan Wilson

“It is not possible to tell what type someone has before their gallbladder is actually removed. More than 80% of all gallstones are not visible in an ordinary X-ray – so this is not really a good diagnostic technique for gallstones. Ultrasound and CT scanning is used in preference and most stones look identical in scans.”

Some researchers are working on ultrasound techniques that can pick up slightly different patterns from cholesterol stones to differentiate them from other types but this is not really that useful for someone who experiences symptoms from their gallstones.

Treatment for someone with symptomatic gallstones is the same no matter what the composition of their stones – the gallbladder needs to be removed surgically, usually by a keyhole cholecystectomy.

Why do people develop cholesterol stones – is it related to having high cholesterol?

As far as we know, gallstones tend to form when the bile, the fluid inside the gallbladder, becomes loaded with cholesterol. This crystalises and forms tiny solid lumps, which then attract more solidifying cholesterol and the stones enlarge.

We have quite a lot of evidence that having high blood cholesterol, being overweight or obese and developing insulin resistance (a step towards type 2 diabetes) does make it more likely that you will develop gallstones. Remember though that although its common to have gallstones as you get into late middle age, most people never develop symptoms. You can be perfectly well and have gallstones for many years. It’s only when they start to cause problems that you need to have treatment.

Can drug treatment to reduce cholesterol prevent gallstones?

Some people think that if high cholesterol is associated with gallstones, statin treatment could help. Statins and a drug called ezetimibe, which are used to treat high cholesterol have been show to change the composition of bile and to reduce the rate at which cholesterol stones form. Two large population s tudies have shown that statins given to people to prevent heart attacks did also reduce their risk of having to have surgical gallbladder removal. However, although other controlled trials were done to find out if statins could prevent the formation of gallstones, these produced conflicting results.

Mr Jonathan Wilson“More research is needed but for the moment the best medical advice is that you should take statins to reduce your risk of heart attack and stroke if you need to and maybe benefit from the reduced risk of gallstones as a secondary effect. They are not prescribed to prevent gallstones if you don’t have a high risk of cardiovascular disease.”