Dr. Widjaja Luman
Consultant Gastroenterologist and General Physician
B Sc (St. Andrews), MB ChB (Man), MRCP (UK), M.D. (Edin),
CCST (UK), FRCP (Edin)

(Ahli penyakit pencernaan dan hepar)


Gallstone disease is a common medical problem. The prevalence of gallstones varies between different ethnic populations. It is estimated to be present in 5% of men and 10% of women. The risk factors for gallstones include increasing age, female gender, pregnancies, obesity, genetic predisposition and various medications (such as estrogen therapy, lipid-lowering drugs).

Gallstones are of two main types : cholesterol and pigment. Gallstones develop as a result of an imbalance in the components of bile. In a normal person, cholesterol in the bile is prevented from forming stones by bile acids and proteins secreted in the bile. Cholesterol stones can be formed when there is too much cholesterol in proportion to bile acids in bile juice in the gallbladder. A diet rich in cholesterol could be a risk factor.


What are the symptoms of gallstones?

Gallstones can be painless and cause no health problems (i.e. asymptomatic). Not everyone with gallstones need medical treatment. If patients with asymptomatic gallstones are followed-up, only 2 – 3% of these patients develop biliary colic (pain from gallstones) every year and 3% eventually develop complications of gallstones.

The complications of gallstones include acute cholecystitis (inflammation of the gallbladder), gallbladder empyema (pus in the gallbladder), and perforation of the gallbladder. If the stone migrates down to bile duct, it can cause jaundice and cholangitis (inflammation of the bile duct), acute pancreatitis (inflammation of the pancreas) and even, septic shock and death.

Fortunately, patients often have prior symptoms of biliary colic before development of complications.   Symptoms like belching, fullness after meals, vague “indigestion” are not typical gallstone symptoms. Typical biliary colic due to gallstones is a persistent severe pain in the upper abdomen, occurring usually after a meal and lasting several hours. Fever occurs when there is cholecystitis or cholangitis.


What treatments are available?

Gallstones that do not cause any symptoms are best left alone as the chance for developing pain and other complications is low.

The treatment of gallstones causing symptoms is cholecystectomy. This is usually performed via laparoscopy which leaves small scars resulting in less pain and a faster recovery after a few days. Sometimes technical difficulties result in conversion to “open ” cholecystectomy to ensure a safe operation and avoid injury of the bile duct.

Gallstones which have migrated into the bile duct can be removed by Endoscopic Retrograde Cholangio-Pancreatography (ERCP) in 90 to 95 per cent of the time. After an incision of the papilla at ERCP, small stones can be removed. Big stones can be crushed into smaller pieces before removal. When stones are too big to be removed, a plastic stent can be inserted to relieve the obstruction. This is especially useful when the patient is frail, is not fit for surgery or refuses surgery.

Oral bile acid (ursodeoxycholic acid) therapy is available to dissolve gallstones. However, only cholesterol stones can be treated and there are several limitations. Dissolution of gallstones occurs in 49% of patients with stones smaller than 10mm and in 29% of those with larger stones. The duration of treatment is six months to two years and stones tend to reform in the gallbladder after treatment is stopped.


    3 Mount Elizabeth #09-01,
    Mount Elizabeth (Orchard) Medical Centre,
    Singapore 228510

    Phone Number

    +65 6732 7675
    +65 6732 7710

    Opening Hours

    Mon – Fri: 0900 – 1700
    Sat: 0900 - 1300

    Appointment Booking