Gallbladder or Biliary Syndrome
Howard F. Loomis
Jr. DC
Gallbladder dysfunction is one of the most common health problems today, and unfortunately, it frequently is overlooked as a causative factor in structural problems, especially those of the head, neck, and shoulders.
I always used the term "biliary" instead of gallbladder because the symptoms of biliary dysfunction are identical whether the patient still has a gallbladder or not. Patients often don't understand that removal of their gallbladder and the stones in it does not change the consistency of bile. Gallstones develop because poor digestion (insufficient stomach acid) causes the bile to become thick and slow-flowing. The bile will remain thick even after the stones are removed unless digestion improves.
Did you know that more than 600,000 cholecystectomies are performed in this country every year despite overwhelming evidence that most are not necessary? Repeated warnings have been printed in medical journals against this practice.
Recognizing symptoms caused by biliary dysfunction
Frequently clinicians are taught that right shoulder pain accompanied by flatulence and indigestion (dyspepsia) are the best indicators, but don't bet on that. Studies have shown that radiation of pain outside the abdomen (to both flanks, both shoulders, and scapula) occurs only 60% of the time. Pain, when it occurs, is always localized in the abdomen. A very frequent finding is the flattening of the mid-thoracic spine (20%) with loss of the normal thoracic kyphosis.
We are told that these symptoms are most frequently found in patients who are female, overweight, fertile, and over 40. It is true that women experience biliary dysfunction and gallstones roughly twice as often as men. It has also been found that the occurrence and size of gallstones increase with age, and depending on the ethnic group, their incidence can range as high as 25 to 44% of the population.
A very good sign of biliary dysfunction and possible gallstone formation comes from simply reviewing your patients' OTC and prescription drugs. There is widespread use of proton pump inhibitors that are prescribed for any symptom of indigestion. Warning labels on those products recommend temporary use for no more than two weeks.
Bloating, belching, and flatulence
Clinical experience has taught me that the production of adequate stomach acid leads to normal digestion. Physiology texts indicate that hydrochloric acid entering the duodenum increases the flow of bile, which is alkaline.
Ultrasounds have shown that gallbladder emptying is unrelated to the fat content of a meal. In fact, there is no proof that gallbladder attacks are precipitated by eating. In one study, "fatty food" intolerance was more common for the controls than for those patients with confirmed gallstones.
Bloating, belching, and flatulence are no more common in patients with gallstones than in the controls without gallstones. Therefore, a causeand-effect relationship cannot be established. Since these symptoms often persist after surgery, gallstones cannot cause them. Obviously, it is important for your patients to know this.
Gallstones usually do not cause symptoms
Three major studies involving more than 3,000 patients found that 67% of all confirmed cases of gallstones were asymptomatic. Other studies placed the figure above 80%.
Most gallstones are found by chance, even in patients with abdominal pain. More gallstones are detected incidentally with the increased use of the abdominal ultrasound. Therefore, the opportunity to recommend gallbladder removal is increasing, and, unfortunately, once the presence of gallstones is confirmed, the usual procedure is to schedule surgical removal of the gallbladder.
Chiropractors skilled in taking a case history and performing abdominal palpation have quite an advantage in detecting and correcting poor diets and digestion. This is very important because patients with gallstones who are asymptomatic are likely to remain so. Studies indicate that the chance of asymptomatic gallstones becoming symptomatic in the next five years is less than 10%. This percentage decreases to less than 1% after 10 years.
Gallbladder removal does not always relieve symptoms that are traditionally thought to be caused by gallstones. Most studies show complete relief of symptoms in 75 to 80% of patients after surgery. However, studies concentrating on the relief of symptoms for those who had symptoms before surgery indicate relief in only about half of the cases. The most persistent symptoms remaining after surgery are flatulent dyspepsia and chronic, dull pain in the upper right quadrant.
Chiropractors skilled in taking a case history and abdominal palpation have quite an advantage in detecting and correcting poor diets and digestion. This is very important because patients with gallstones who are asymptomatic are likely to remain so. Studies indicate the chance of asymptomatic gallstones becoming symptomatic in the next five years is less than 10%. This percentage decreases to less than 1% after ten years.
Acute gallbladder attacks
An acute gallbladder attack should be used as the indication for surgery—not the accidental finding of gallstones. An acute attack consists of severe "colicky pain" (spasmodic wave-like) or constant pain lasting up to four hours (cystic duct obstruction), which is occasionally accompanied by a low-grade fever (only 13% of the time), and characteristically followed by a "washed-out" feeling for up to 24 hours. The occurrence of constant pain is much more common (57 to 94%) than the colicky, wave-like pain.
Statistics used in this article came from the University of Illinois-Chicago School of Medicine.
Howard F. Loomis, Jr., DC, has an extensive background in enzymes and enzyme supplements. He is the founder and president of the Food Enzyme Institute. His extensive knowledge of physiology, biochemistry, and enzymology has made him a sought-after speaker and a prolific writer.
If you have questions, you can reach The Food Enzyme Institute at 800-662-2630 or go online to www.foodenzymeinstitute.com
