Expert: John Pilcher, MD - 12/29/2009

Question
Hello. I've read recently that gallstones/ gall bladder attacks are common after gastric bypass. What is the likelyhood of these things happening and what symptoms should be watched for?

Answer
Rueben,
Anytime there is a dramatic reduction in food intake it creates a stress on the gallbladder.  Therefore, one can form gallstones after any type of massive weight loss.

For the gastric bypass, the rate of gallstone formation runs 10-15% in the first 2 years after surgery IF nothing is done to thin the bile (bile is the digestive juice stored by the gallbladder, which "thickens" into sludge from which gallstones form).  For the last 15 years or so, most surgeons prescribe some type of bile thinning medication such as ursodiol for their patients to take during the rapid weight loss phase.  Use of this type of gallbladder protection has reduced the rate of gallbladder problems to about 2%.

Symptoms of gallbladder problems usually begin at a low level and progress in severity.  The most common symptoms are "episodes" or "attacks" of pain soon followed by nausea.  The pain is typically located at the top right of the abdomen, on the edge of the ribs, and it may point toward the center "solar plexus" or toward the back.  These episodes or attacks are often brought on by food intake, though that is not a reliable feature.

I hope this is helpful for you.

Dr JP