ROJoson PEP Talk: Gallbladder Stones - How Effective and Useful are Non-Surgical Treatment?

1. May 25, 2024
1400H - 1500H
Via Zoom
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Empowerment
objective - for laypeople
to have an essential
understanding on the
EFFECTIVENESS,
USEFULNESS and
LIMITATIONS OF NON-
SURGICAL TREATMENT
FOR GALLBLADDER
STONES
as part of their health
management.

2. May 25, 2024
1400H - 1500H
Via Zoom
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Empowerment
objective - for laypeople
to have an essential
understanding on the
EFFECTIVENESS,
USEFULNESS and
LIMITATIONS OF NON-
SURGICAL TREATMENT
FOR GALLBLADDER
STONES
as part of their health
management.
Welcome all!
MUTE yourself but always
show your video picture.
Sign in your name, FB
account, or email address in
the Chat Box! Include names
of companions attending.
Use the Chat Box to ask
questions and make
comments while the PEP TALK
is on.
There will be group pictures
at start and end of PEP TALK –
show your face in video.

3. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

4. Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.

5. GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Empowerment
objective - for laypeople
to have an essential
understanding on the
EFFECTIVENESS,
USEFULNESS and
LIMITATIONS OF NON-
SURGICAL TREATMENT
FOR GALLBLADDER
STONES
as part of their health
management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

6. GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Empowerment
objective - for laypeople
to have an essential
understanding on the
EFFECTIVENESS,
USEFULNESS and
LIMITATIONS OF NON-
SURGICAL TREATMENT
FOR GALLBLADDER
STONES
as part of their health
management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START PEP TALK
PROPER IN 2
MINUTES!
Pls. turn on your
video!
Show your face!

7. GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Empowerment
objective - for laypeople
to have an essential
understanding on the
EFFECTIVENESS,
USEFULNESS and
LIMITATIONS OF NON-
SURGICAL TREATMENT
FOR GALLBLADDER
STONES
as part of their health
management.
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

8. I started the PEP Talk
on May 15, 2021
during the COVID19
Pandemic. There are
3 courses in the PEP
Talk. I completed the
Core Course on
October 9, 2021.

9. From October 23, 2021
onwards, I have been
tackling Health Disorder
and Health Issue Courses.
May 18, 2024 marks the
start of YEAR 4 of
ROJoson PEP Talk.
How long the PEP Talk
will last will depend on
our enthusiasm,
discipline and
perseverance.

10. L
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Empowerment
objective - for laypeople
to have an essential
understanding on the
EFFECTIVENESS,
USEFULNESS and
LIMITATIONS OF NON-
SURGICAL TREATMENT
FOR GALLBLADDER
STONES
as part of their health
management.
My PEP TALK today is
entitled:
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE NON-
SURGICAL
TREATMENT?

11. Contents
• What are gallstones or gallbladder stones?
• What are the different types of gallstones?
• What are the causes of gallstones?
• Do all patients with gallstones have symptoms?
• Do all patients with gallstones need treatment?
• What are the commonly heard non-surgical treatment
for gallstones?
• How effective and useful and what are the limitations of
non-surgical treatment?
• What are the advice on non-surgical treatment for
gallstones?
Disclaimer:
ROJoson PEP Talk
contains ROJoson’s
Thoughts,
Perceptions,
Opinions and
Recommendations
(TPORs) culled from
experiences of
ROJoson and
writings of other
health professionals.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?

12. What are gallstones or gallbladder
stones?
Gallstones are hardened, concentrated
pieces of BILE that form in gallbladder
or bile ducts.
“Gall” means bile, so gallstones are
bile stones. Gallbladder is the bile
bladder. It holds and stores bile for
later use. The liver makes bile, and the
bile ducts carry it to the different
organs through the biliary tract.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://my.clevelandclinic.org/health/diseases/7313-
gallstones

13. What are gallstones or gallbladder
stones?
Gallstones form when bile sediment
collects and crystallizes. Often, the
sediment is an excess of one of the
main ingredients in bile.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://my.clevelandclinic.org/health/diseases/7313-
gallstones

14. What are the different types of gallstones?
• Cholesterol stones
• Pigment stones
• Mixed stones with calcium salts – most
common in the Philippines
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?

15. What causes gallstones?
Gallstones may form if bile contains too much
cholesterol, too much bilirubin, or not enough
bile salts.
Researchers do not fully understand why these
changes in bile occur.
Gallstones also may form if the gallbladder does
not empty completely or often enough.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://www.niddk.nih.gov/heal
th-information/digestive-
diseases/gallstones/symptoms-
causes#:~:text=Gallstones%20m
ay%20form%20if%20bile,empty
%20completely%20or%20often
%20enough.

16. What causes gallstones?
Gallstones are thought to develop because of an
IMBALANCE in the chemical make-up of bile
inside the gallbladder. The exact cause of the
imbalance is not known.
Gallstones form when there’s an excess of one of
the main ingredients in bile.
The excess ingredient turns to sediment at the
bottom of your gallbladder or bile ducts, and the
sediment gradually hardens into stones.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://my.clevelandclinic.org/h
ealth/diseases/7313-gallstones

17. Do all patients with gallstones have symptoms?
Gallstones can be asymptomatic or symptomatic
(with symptoms, particularly pain at the right
upper quadrant of the abdomen).
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?

18. t
Do all patients with gallstones need treatment?
If the gallstones never cause problems, NO
treatment is needed. If they are causing pain,
treatment is needed.
If gallstones cause a blockage in the biliary tract,
the blockage have to be remedied — not just the
blockage, but all of them (gallstones).
Once gallstones have caused a blockage, they’re
highly likely to do so again.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://my.clevelandclinic.org/h
ealth/diseases/7313-gallstones

19. Do all patients with gallstones need treatment?
Most people who need treatment for gallstones
will have surgery to remove them. SURGERY IS
THE ONLY WAY TO ENSURE GALLSTONES WON’T
CAUSE ISSUES AGAIN.
But if you can’t or don’t want to have surgery, it
is said there are some alternative treatments to
try, including medications and other procedures.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://my.clevelandclinic.org/h
ealth/diseases/7313-gallstones
The question is:
HOW EFFECTIVENESS
AND USEFUL ARE THE
NON-SURGICAL
TREATMENT FOR
GALLSTONES?
Our main topic /
issue for discussion in
this PEP Talk!

20. ive
What are the commonly heard non-surgical
treatment for gallstones?
- Observation
- Gallbladder cleanse or flushing
- Medications
- Avoidance of fatty foods
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
The question is:
HOW EFFECTIVENESS
AND USEFUL ARE THE
NON-SURGICAL
TREATMENT FOR
GALLSTONES?
Our main topic /
issue for discussion in
this PEP Talk!

21. What are the commonly heard non-surgical
treatment for gallstones?
Observation
- The risks of developing symptoms or complications
from gallstones in patients who have no symptoms is on
the order of 20% over 20 years. Thus, patients who are
older than 40 years of age and have no other
indications for gallbladder treatment can be
observed. Although there is a risk of having an attack at
an inopportune time or developing one of the
complications, this is small. However, patients with
symptoms should consider treatment.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Observation
is the
recommendation if
there are NO
symptoms associated
with the gallstones
because it is believed
that gallbladder
cleansing or flushing
and medications are
not effective or cost-
effective.
https://www.lifespan.org/centers-services/general-and-
gastrointestinal-surgery/about-gallstones/non-surgical-treatments

22. What are the commonly heard non-surgical
treatment for gallstones?
Observation
- Observation is recommended for patients with
asymptomatic gallstones.
- As only about 4% of patients with
asymptomatic gallstones develop symptoms
including cholecystitis, obstructive jaundice,
pancreatitis, and gallbladder cancer.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Observation
is the
recommendation if
there are NO
symptoms associated
with the gallstones
because it is believed
that gallbladder
cleansing or flushing
and medications are
not effective or cost-
effective.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923050/#:~:text=Cholecystectomy%20is%20curr
ently%20advised%20only,%2C%20pancreatitis%2C%20and%20gallbladder%20cancer.

23. What are the commonly heard non-surgical
treatment for gallstones?
Observation
- Observation is recommended for patients with
asymptomatic gallstones.
- Patients developed symptoms at a rate of
approximately 1% to 2% per year. Complications were
rare (approximately 4% over 25 years) except when
preceded by biliary colic. Complications typically
include acute cholecystitis (0.3% per year), obstructive
jaundice (0.2% per year), acute pancreatitis (0.04% to
1.5% per year), and gallstone ileus (rare).
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Observation
is the
recommendation if
there are NO
symptoms associated
with the gallstones
because it is believed
that gallbladder
cleansing or flushing
and medications are
not effective or cost-
effective.
https://www.aafp.org/pubs/afp/issues/2014/0315/p468.html#:~:text=Complications%20were%20
rare%20(approximately%204,and%20gallstone%20ileus%20(rare).

24. s
What are the commonly heard non-surgical
treatment for gallstones?
Observation
- Observation is the best form of therapy for
patients with asymptomatic gallstones.
- Surgical management offers the least risk and
greatest benefit to patients with symptomatic
gallstones.
- Gallbladder cleansing / flushing are
ineffective.
- Medication – dissolution therapy is not cost-
effective.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Observation
is the
recommendation if
there are NO
symptoms associated
with the gallstones
because it is believed
that gallbladder
cleansing or flushing
and medications are
not effective or cost-
effective.
https://pubmed.ncbi.nlm.nih.gov/3945594/

25. What are the commonly heard non-surgical
treatment for gallstones?
Medicines to dissolve the gallstones
• There are medicines in the market
(particularly, URODEOXYCHOLIC ACID)
commonly prescribed by physicians for
patients with gallstones.
• These are expensive (about P50 / cap) and
these are usually taken 3 x a day for 6 to 12
months (minimum of 3 months).
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?

26. What are the commonly heard non-surgical
treatment for gallstones?
Medicines to dissolve the gallstones
• The drug works only in patients who have
cholesterol or primarily cholesterol stones.
• Majority of gallstones in the Philippines are
mixed stones.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://www.lifespan.org/centers-services/general-and-
gastrointestinal-surgery/about-gallstones/non-surgical-treatments

27. What are the commonly heard non-surgical
treatment for gallstones?
Medicines to dissolve the gallstones
• Patients with cholesterol gallstones who take
the drug for two years have a 20% chance of
having their gallstones dissolved.
• These patients need to continue taking once
per day after the stones dissolve since their
gallbladder remains diseased and there is a 30
to 50% chance of recurrence of gallstones in 3
to 5 years without further treatment.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://www.lifespan.org/centers-services/general-and-
gastrointestinal-surgery/about-gallstones/non-surgical-treatments
Conclusion:
It is not cost-effective
to take dissolution
therapy
(urodeoxycholic acid)
for gallstones.
It can take months or
years for all of the
gallstones to break
up.
There is recurrence.

28. What are the commonly heard non-surgical treatment for gallstones?
Gallbladder Cleanse or Flushing
Gallbladder Cleanse Myths
If you see a gallbladder cleanse promoted, it most likely encourages you to eat
or drink olive oil in combination with a particular fruit juice over a certain
period of time. Claims include that these ingredients break up gallstones in
your gallbladder and stimulate your body to pass them in your stool when you
use the bathroom.
Olive oil does have laxative properties, but there is no proof that it has an
impact on gallstones. If you look at your stool following an olive oil cleanse,
you may see lumps in your stool that you suspect are gallstones. Instead, they
are GLOBS of olive oil, juice, and other food from your digestive tract.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://www.webmd.com/digestive-disorders/what-is-a-gallbladder-
cleanse

29. Gallbladder Cleanse or Flushing
Using apple / apple juice, Epsom salt, olive oil, lemon juice
First five days
You can eat 4-5 apples or drink 4 glasses of apple juice for the first five days.
Sixth day –
Skip your evening meal. Instead, you have to drink a big cup of warm water along with a
teaspoon of Epsom salt mixed in it. Repeat this process again after 1.5 hours. This will aid in
releasing the gallstones.
With your second drink of warm water and Epsom salt, you can try various combinations for
proper lubrication that will help in releasing the bladder stones out of your bladder. You can
add a tablespoon of sesame oil or olive oil in this drink. Else, you can mix lemon juice of a
whole lemon in this drink.
Seventh-day
You will have your bowel movement. You will observe stones with a greenish tint in your
stools.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://www.pristyncare.com/blog/apple-juice-for-gallstones-
removal-naturally-pc0113/

30. What are the commonly heard non-surgical
treatment for gallstones?
Avoiding fatty foods won't prevent or get rid of
gallstones, but it may reduce the frequency of
attacks.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://www.health.harvard.edu/womens-health/what-to-do-
about-gallstones

31. What are the commonly heard non-surgical
treatment for gallstones?
Changing your diet won't get rid of gallstones
that are already there, but eating a healthy,
balanced variety of nutrients and limiting the
amount of saturated fats and cholesterol-heavy
food you eat may help ease your symptoms.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://www.webmd.com/digestive-disorders/features/gallbladder-
diet-foods-for-gallbadder-problems

32. one
What are the commonly heard non-surgical
treatment for gallstones?
Lithotripsy
Lithotripsy, or shock wave dissolution of
gallstones, is a technique that uses a highly
focused sound wave to break the stones up into
tiny particles that can then pass through the
cystic duct into the common duct and out into
the intestine.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
https://www.lifespan.org/centers-services/general-and-
gastrointestinal-surgery/about-gallstones/non-surgical-treatments

33. in
What are the commonly heard non-surgical
treatment for gallstones?
Lithotripsy
Can be used for small single stones (not more
than 2cm).
Gallstones may recur – high incidence.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?

34. What are the advice on non-surgical treatment for gallstones?
For asymptomatic gallstones, just observe. Avoid fatty foods.
For symptomatic gallstones, go for surgery to remove the whole
gallbladder with the stones.
Do not go for gallbladder cleanse and flushing as it is not effective.
Do not go for oral dissolution medications (such as urodeoxycholic acid)
as it is not cost-effective.
If you do not want surgery, eat healthy diet, exercise, avoid fatty foods,
drink a lot of water and hang-on.
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?

35. t
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Summary
Take Away
Contents
• What are gallstones or gallbladder stones?
• What are the different types of gallstones?
• What are the causes of gallstones?
• Do all patients with gallstones have symptoms?
• Do all patients with gallstones need treatment?
• What are the commonly heard non-surgical treatment
for gallstones?
• How effective and useful and what are the limitations of
non-surgical treatment?
• What are the advice on non-surgical treatment for
gallstones?

36. GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on EFFECTIVENESS, USEFULLNESS
AND LIMITATIONS OF NON-SURGICAL TREATMENT
ON GALLBLADDER STONES.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan to gain greater control over
decisions / make better decisions on
EFFECTIVENESS, USEFULLNESS AND LIMITATIONS
OF NON-SURGICAL TREATMENT ON
GALLBLADDER STONES as part of your health
management.

37. GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Empowerment
objective - for laypeople
to have an essential
understanding on the
EFFECTIVENESS,
USEFULNESS and
LIMITATIONS OF NON-
SURGICAL TREATMENT
FOR GALLBLADDER
STONES
as part of their health
management.
This ends my PEP
TALK today on:
GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE NON-
SURGICAL
TREATMENT?

38. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

39. Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.

40. GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Empowerment
objective - for laypeople
to have an essential
understanding on the
EFFECTIVENESS,
USEFULNESS and
LIMITATIONS OF NON-
SURGICAL TREATMENT
FOR GALLBLADDER
STONES
as part of their health
management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

41. GALLBLADDER
STONES – HOW
EFFECTIVE AND
USEFUL ARE
NON-SURGICAL
TREATMENT?
Empowerment
objective - for laypeople
to have an essential
understanding on the
EFFECTIVENESS,
USEFULNESS and
LIMITATIONS OF NON-
SURGICAL TREATMENT
FOR GALLBLADDER
STONES
as part of their health
management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START Q&A AND
INTERACTIONS!
Pls. turn on your
video!
Show your face!