Biliary Tract Diseases: Information and Specialists

The bile ducts are small structures known as canaliculi (= structures that run through a canal). They carry bile from the liver to the duodenum.

There are a number of diseases that affect the biliary tract. These primarily include:

• Gallstones
• Cholangitis (inflammation of the bile ducts)
• Cholecystitis (inflammation of the gallbladder)
• Cholestasis (bile stasis)
• Biliary colic
• Caroli syndrome (a rare inherited disorder characterized by frequent inflammation and gallstones)
• Cholangiocarcinoma (cancer of the bile ducts)

If you experience recurring discomfort in the upper right abdomen, you should see a specialist. A gastroenterologist is the specialist responsible for treating gallbladder disorders. Gastroenterology is a subspecialty of internal medicine. It focuses primarily on the gastrointestinal tract and associated organs, including the gallbladder and bile ducts.

Depending on the findings, your treating physician may refer you to a hepatologist. Hepatology is a subspecialty within gastroenterology. It deals specifically with diseases of the bile ducts and the liver.

The location of the gallbladder beneath the liver © magicmine | AdobeStock

Symptoms related to the biliary tract usually manifest as pain in the upper right abdomen. To the layperson, these symptoms are initially very nonspecific and difficult to interpret, especially since they typically occur irregularly.

If the symptoms become chronic, abdominal pain in the region of the liver is a common symptom. The pain is often mild but occurs very regularly.

In addition, there are episodes of very severe pain, also in the right upper abdomen. These are accompanied by nausea, sometimes fever, and occasionally vomiting. If you experience such severe symptoms, you may be suffering from acute biliary colic caused by gallstones.

Gallstones are the main cause of most biliary tract diseases. They consist of various substances, such as calcium or cholesterol. In most cases, multiple stones are present at the same time. Their size ranges from a few millimeters to several centimeters.

Many patients are completely unaware that they have gallstones. Gallstones can sometimes dissolve on their own or be small enough to be flushed out of the body.

However, some gallstones cause problems and lead to significant symptoms.

The cause of gallstone formation is usually a change in the composition of bile. Gallstones usually form in the gallbladder. When the stones move, they enter the bile ducts. There, they can potentially block a bile duct. Bacterial infections are a major complication that can result from this.

After age 40, the risk of developing gallstones increases significantly. Women are up to three times more likely to be affected than men.

Being overweight is considered a primary risk factor, as is taking estrogen as part of hormone therapy.

The formation of gallstones can also be genetic. An unhealthy diet can also lead to changes in the composition of bile.

Gallstones in the gallbladder or bile ducts are one of the most common biliary tract diseases © Henrie | AdobeStock

Your doctor will first discuss your symptoms with you in detail and, if necessary, perform a physical examination. In most cases, a stool sample and a blood sample are sent to the lab.

If gallstones are present, they can often be detected by certain elevated liver enzyme levels in the blood sample. If your pain is accompanied by impaired fat digestion, this can be identified in the stool sample.

Another diagnostic option is sonography (ultrasound). This allows for very clear visualization of gallstones, their exact location and position, their number, and their size.

An important diagnostic procedure is ERCP (endoscopic retrograde cholangiopancreatography). ERCP uses a combination of an endoscope and X-ray contrast dye. The doctor uses this procedure to examine the interior of the bile ducts and the gallbladder. Pathological changes and inflammation can thus be easily detected.

In the case of gallstones, your doctor will initially opt for observation, provided you are asymptomatic. If you experience frequent biliary colic, it is generally advisable to remove the gallstones to prevent them from entering the bile duct.

Depending on the composition and size of the stones, it may be possible to dissolve them. Another option is to break them up from the outside using shock wave therapy. This method is already used successfully for kidney stones and is now increasingly being used for gallstones as well.

Surgical removal is possible via the minimally invasive ERCP procedure using a probe. This operation is particularly suitable for individual stones located in the bile duct.

In cases of chronic inflammation of the gallbladder, the doctor will usually perform a cholecystectomy. In addition, you will likely be prescribed antibiotics as part of your treatment.

If a tumor is present, the gallbladder is also removed as part of biliary surgery. If the tumor is malignant, additional chemotherapy may be considered.

The course of biliary tract diseases depends primarily on the specific symptoms and the associated clinical picture. Diet also often plays a role.

Gallstones are initially monitored and often do not require treatment if they do not cause significant problems. Removal is only recommended if the stones become lodged and cause inflammation. However, it is possible that new stones may form at some point.

In cases of chronic inflammatory processes, removal of the gallbladder is often necessary. In such cases, no major limitations are generally expected in the long term.

Biliary tract diseases usually lead to discomfort and symptoms in the upper right abdomen. If the pain is recurrent or comes in waves, you should see a doctor.

A gastroenterologist is the right specialist to consult to determine the cause of your symptoms.