Are Body Mass Index and Bile Duct Stones linked?

Obesity tripled in the last four decades, and was called a “global pandemic in its own right” by United Nations in 2020. Obese people are more susceptible to suffering or dying from Covid-19 complications and vulnerable to heart disease, stroke, cancer, diabetes, fatty liver, and chronic kidney disease. Diet, lack of exercise, social environment and genetics are major triggers for obesity.

Moreover, consumption of ultra-processed food items, fast-food restaurant meals, soft drinks, and industrially processed convenience food with salt, sugar, fat, and additives lead to obesity. Besides having an adverse impact on respiratory and cardiac problems, obesity is a major risk factor for stone formation in the body. Considering the startling facts and statistics, on this World Digestive Day, let’s zoom in on problems such as gallstones that are a result of obesity.

Inputs by Nirmaljeet S Malhi, Director and Senior Consultant at AGI -- The Gastrociti, Ludhiana and Debasis Datta, Senior Consultant Gastroenterologist and Hepatologist Director, Fortis Hospitals, Kolkata and Overseas Advisor at Royal College of Physicians, London.

Body mass index (BMI) defined as weight in kilograms divided by square of height in centimetres, is a measure of body fat that applies to adults, and its results ranges from underweight to obesity. More than 135 million people are obese (BMI > 30Kg/cm2) in India. Now, with the increase in BMI, the risk of non-cardiac diseases has grown exponentially.

People who eat a high fat diet, have a sedentary lifestyle and are obese develop gallstones that in turn lead to bile duct stones. When cholesterol, calcium salts and bilirubin deposit in gallbladder, they form gallstones. The gallbladder contains digestive fluid called bile that is passed into the small intestine via bile duct. In some cases, stones that form in gallbladder slip into bile duct and get trapped in it. These are known as common bile duct (CBD) stones.

A stone in the bile duct can cause pain, block the bile duct, and damage the liver, pancreas, and digestive system. A person with bile duct stones usually experiences pain in the upper abdomen, back or shoulder, and around the ribs. Some people can also develop jaundice which may cause their skin and eyes to appear yellow along with fever and/or chills. A subset of patients can develop pancreatitis due to CBD stones that is a major medical emergency and could result in death in 5-10 per cent of cases, if not treated in time. When one develops such symptoms, it becomes imperative to seek timely medical invention and to undergo the required treatment.

The doctor can confirm the diagnosis through medical history, physical examination of the abdomen, blood tests and imaging tests like ultrasonography of the abdomen. In cases of diagnostic uncertainty, Endoscopic Ultrasound (EUS) or MRCP have emerged as the modalities of choice. The treatment of CBD stones is done by a specialised endoscopic procedure called as ERCP (Endoscopic retrograde cholangiopancreatography). The dye is injected into the bile duct during this procedure that provides a clear visibility to locate bile duct stones causing the blockage, which in turn are removed by giving a small incision in a region called papilla in upper part of small intestine.

ERCP has been used for decades for diagnosis and treatment of bile duct stones. However, today, technological breakthroughs have redefined healthcare in India. We now have procedures like Cholangioscopy that enable faster and more accurate treatment in difficult to remove CBD stones, reduced risk associated with repeated procedures and give patients a better quality of life.

The therapy is used to treat bile duct stones that cannot be treated using traditional methods and for elderly patients. A small straw like tube with a camera and light at the end is used to disintegrate stones. The doctor monitors the stone location on a screen and bursts the stone using a tiny probe attached in the tube.

While an outright control of gallbladder problems is inevitable, people can take appropriate measures to reduce the risk of developing stones and associated symptoms and complications. To prevent gallbladder or bile ducts stones, it is imperative to reduce overweight and obesity. Choice of healthier foods and regular exercise can go a long way in preventing obesity. One can limit energy intake from sugars and total fats, increase consumption of vegetables, fruits, grains, and nuts and engage in physical activities for at least 60 minutes a day.

Although a lifestyle modification is the key to weight loss, newer endoscopic approaches like Intra-Gastric Balloon and Endoscopic Sleeve Gastroplasty are new additions to a Gastroenterologist’s armamentarium to tackle obesity. As per the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), women and people over 40, obesity and a family history of stones are more prone to getting gallstones or bile duct stones. Gallbladder problems are usually managed easily in expert hands now-a-days. The main solution for managing stones is to spread awareness about the root cause and potential treatment options available.