From the Guidelines
Gallbladder sludge can often be managed through dietary changes and medication, with ursodeoxycholic acid (ursodiol) at 8-10 mg/kg/day in divided doses for 3-6 months being a recommended treatment option to dissolve the sludge by decreasing cholesterol secretion into bile 1.
Key Considerations
- Start by adopting a low-fat diet, as fats trigger gallbladder contractions that can cause pain when sludge is present.
- Increase fiber intake through fruits, vegetables, and whole grains while staying well-hydrated with 8-10 glasses of water daily to help thin the bile.
- For medication, ursodeoxycholic acid (ursodiol) at 8-10 mg/kg/day in divided doses for 3-6 months can dissolve the sludge by decreasing cholesterol secretion into bile.
- If pain occurs, over-the-counter NSAIDs like ibuprofen (400-600 mg every 6 hours) can provide relief.
- Regular exercise also helps by promoting gallbladder emptying and improving bile flow.
Important Notes
- For persistent sludge causing symptoms, consult a healthcare provider as cholecystectomy (surgical gallbladder removal) may be necessary.
- Gallbladder sludge forms when bile components like cholesterol and calcium bilirubinate precipitate, creating a thick, mud-like substance that can lead to inflammation or stone formation if left untreated.
- Nonsurgical therapy dissolves gallstones by solubilizing their cholesterol through various methods, but is generally limited to gallstones with a diameter less than 1.5 cm and whose content is primarily cholesterol 1.
Treatment Options
- Expectant management: a wait-and-see position in which intervention is postponed until a more serious problem develops.
- Nonsurgical therapy: dissolves gallstones by solubilizing their cholesterol through various methods.
- Surgical removal of gallstones and gallbladder (cholecystectomy): prevents future pain, complications, gallstone recurrence, and gallbladder cancer.
From the Research
Treatment Options for Gallbladder Sludge
- Medical treatment is indicated for patients who are not fit or are afraid of surgery, and gallstones must be cholesterol rich and the cystic duct must be patent 2.
- Ursodeoxycholic acid (UDCA) is a bile acid that dissolves gallstones and can be used to treat symptomatic gallstone disease, including gallbladder sludge 3, 4, 5.
- The choice of treatment depends on the size and number of gallstones, with oral bile acids being effective for small stones and lithotripsy combined with oral bile acid for larger stones 2.
- UDCA has been shown to be safe and effective in dissolving cholesterol gallstones, with a significant reduction in gallstone volume and number 4, 5.
Effectiveness of Ursodeoxycholic Acid (UDCA)
- UDCA has been found to be effective in dissolving gallstones, with a complete dissolution rate of up to 100% in some studies 4, 5.
- The effectiveness of UDCA can depend on the dose and duration of treatment, with higher doses and longer treatment durations resulting in better outcomes 4, 5.
- UDCA has also been found to be effective in normalizing the contractile function of the gallbladder and reducing the severity of biliary sludge 5.
Comparison of Treatment Options
- A comparison of UDCA from different manufacturers found that the German substance UDCA (Ursofalk) was more effective than generic drugs from other manufacturers in treating biliary sludge 5.
- The study found that Ursofalk resulted in a higher complete resolution rate of biliary sludge (93.5% vs 73.6%) and a higher normalization rate of the contractile function of the gallbladder (71% vs 47.1%) compared to the generic drug 5.