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Could Gallstones Be Expelled?
It seems likely that gallstones
might occasionally be expelled.
Small stones are regularly expelled
from the gallbladder.
There is some risk that stones over
about 5mm in diameter will lodge
in the bile duct, but most pass on
into the bowel and out of the body unnoticed.
Gallbladders may spontaneously
empty themselves of small stones,
but this is rare [9].
Also, the large oily meal would stimulate
strong gallbladder contraction.
This could help expel small gallstones
or even, very rarely, a whole crop of
small gallstones or sludge.
Whether the whole ritual is
needed is another matter.
A meal of fried fish and chips,
or the whole fat milk and a Mars bar
sometimes used to stimulate
gallbladder contraction during
x-ray examinations might serve as well.
The magnesium sulphate (Epsom Salts)
could have an added effect,
as it also stimulates gallbladder contraction
and relaxes the muscles controlling
the release of bile into the intestines.
However, it acts in the same way as
would fat or oil, causing the release of
cholecystokinin from
the upper small intestine [10].
The availability of that hormone
and the ability of the gallbladder
to respond to it would be limiting factors.
The chance of success is
further diminished by the fact that
patients with symptomatic gallstones
often have impaired ability of
the gallbladder to empty
(a factor in gallstone formation),
stones that are too big to pass,
or a blocked gallbladder duct
(the non-functioning gallbladder
in contrast studies).
Moreover, it can be predicted that
even if occasionally successful,
most patients would go on to
form more stones.
After successful dissolution of
gallstones with ursodeoxycholic acid,
30-50% of patients form
new stones within five years [11].
Despite much research, no simple,
safe, or dietary measure
has been found to prevent gallstone formation.
The traditional fat-free diet has shown
no consistent benefit [12],
possibly because an occasional fatty meal
helps expel small stones or sludge.
This may be why patients on
prolonged intravenous feeding are
prone to develop gallstones.
In a popular variant, large quantities of
apple juice are consumed in the days prior to
the olive oil and lemon juice (or equivalent).
Its supporters claim that apple juice is
a stone solvent [13], usually offering in
support a reference to
the prestigious medical journal,
The Lancet [14]. The cited item,
Apple juice and the chemical-contact
softening of gallstones, is
merely a brief letter to
the editor stating that the writer's wife
had passed soft, brown, fatty stones
after drinking a lot of apple juice
and then a cupful of olive oil,
apparently as part of a gallbladder flush.
This source offers no evidence that
apple juice can soften gallstones.
Actually, there is no way for apple juice
or any other agent taken by mouth
to come into contact with stones
in the gallbladder or bile ducts.
A very effective sphincter muscle
prevents intestinal contents
from leaking back into the bile duct
or gallbladder. Thus there is
no logical reason to believe that
any of the materials consumed
in the "flushes" (oils, fruit juices,
magnesium sulfate) could soften
or otherwise affect
the characteristics of gallstones
in the gallbladder or bile ducts.
Bile salts such as ursodeoxycholic acid
can do so, but they must be absorbed
into the blood stream and processed by
the liver before they can affect
the ability of bile to dissolve
cholesterol stonesand a minimum of
nine months of treatment is usually required.
| จากคุณ |
:
Ms. Kim  
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| เขียนเมื่อ |
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7 มี.ค. 55 18:50:09
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