To Remove the Gallbladder or Not? What About Treatment Afterward?

One of the most common operations performed in older adults is gallbladder removal. However, researchers at the University of Texas have put together data that indicates patients who are most likely to benefit from gallbladder removal fail to receive the procedure. Previously, the researchers had conducted a study identifying different factors that are associated with acute gallbladder attack – these factors include: age, sex, race, and other illnesses. The same researchers later used this data to create a predictive model to determine patients most at risk, as well as patients most likely to benefit from the operation.

To test the predictive model, the researchers looked at 11 years of billing records of over 180,000 Texas Medicare patients. All of the patients were at least 66 years old with history of gallstone issues. The predictive model was aimed at determining which patients were most likely to experience a dangerous gallbladder episode within two years. Obviously, the patients at most risk for a gallbladder issue should be the first to receive gallbladder removal surgery, however, the study indicated alternative outcomes. In fact, patients who were most in need of gallbladder removal did not receive the operation. One of the researchers explained that although gallbladder removal is recommended for patients with gallstones, less than a quarter of patients in the study actually had their gallbladder removed. The researchers wished to understand if this decision was based on the patient’s risk of complication in the following couple of years.

By placing the patients into three groups, identified as having low, moderate, or high risk for an acute gallbladder episode, the accuracy of the predictive model was confirmed. In the high-risk group, 65% were hospitalized within the two-year period. Less than 20% of the low-risk group required hospitalization (even though their gallbladder was not removed). When the researchers looked at patients who had surgery, they found that the risk was unrelated to gallbladder removal. 22% of the people in the low-risk group, 21% in the moderate-risk group, and 23% in the high-risk group had their gallbladder removed.

It’s well documented that the risk of gallstones increases with age. Those who are under 40 have about an 8% chance of developing gallstones, and in those who are over 70 – the risk jumps to more than 50%. In patients who are over 65, gallbladder disease is the most common cause of acute abdominal pain, and gallbladder removal accounts for a third of abdominal patients this age. The researchers believe that the study and predictive model may help provide individualized care and more informed decision-making, especially in older patients suffering from gallstones. If the predictive model is used at the primary care level, it may help physicians improve patient outcomes. Additionally, elective gallbladder removal rates may be improved, which may also help to prevent future complications in the elderly. For now, patients placed in low-risk categories are given the choice regarding gallbladder removal, however – this information may help these patients make more informed decision regarding their health choices.

Treatment Post-Gallbladder Removal

The gallbladder is a small organ that acts as a storage compartment for bile (produced by the liver). Bile helps the body digest dietary fats in the small intestine. Once bile is produced in the liver, it passes through ducts and is pushed into the gallbladder for storage. After consumption of fat and protein, sensory receptors in the small intestine respond by producing a hormone that travels to the gallbladder. The gallbladder is stimulated to release the bile through this chemical reaction, and muscle contractions help to push the bile to the small intestine. Once in the small intestine, bile and enzymes help to break down the food particles so they’re readily absorbed from the small intestine and into the bloodstream.

Although the gallbladder does have important function in terms of digestion, it is not absolutely essential for good health. When patients experience persistent gallstones, removing the gallbladder entirely is sometimes the best option. When the gallbladder is removed, bile flows directly from the liver to the small intestine – sometimes causing symptoms like diarrhea. In addition, bile is longer capable of being stored for later use, which means the body will have difficulty digesting meals that contain high portions of fat and protein. For this reason, patients often follow a restricted diet, and physicians will often recommend a good digestive enzyme. Choosing a digestive enzyme specialized for fat and protein breakdown, when combined with a dietary strategy can help to prevent symptoms like diarrhea and nutrient intolerance. Even for patients lucky enough to evade symptoms after gallbladder removal, digestive enzymes are essential for optimal nutrient absorption. When the body is without a gallbladder, it becomes less equipped to handle large amounts of food at once, or even healthy meals that contain beneficial fats (like avocado, fish, and nuts). For some, digestive enzymes allow the patient to have a cheat meal without experiencing significant symptoms. For most patients, however, digestive enzymes offer people the comfort of not having to be obsessive over food labels. More importantly, it may help to reduce the use of over the counter medications for digestive symptoms.

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