Gallbladder Polyps- all that you want to know

The gallbladder, also called the cholecyst, is a hollow organ near the liver primarily concerned with bile storage and concentration. The bile is subsequently released into the duodenum of the small intestine, which helps break down food and absorb fats. Constant interaction with acidic bile and interaction with cholesterol components make the gallbladder susceptible to growths in and around it in the form of gallstones and gallbladder polyps.

What is Gallbladder Polyps

Gallbladder polyps are growths projecting from the internal wall of the gallbladder that in 95% cases are benign, asymptomatic and go undetected. These polyps are discovered accidentally during other investigative findings and, apart from regular monitoring, do not require intervention or treatment strategies. The remaining 5% of the polyps tend to be of a cancerous nature and need surgical intervention in the earliest possible manner to determine the level of metastasis in the body.

Usually, the size of a polyp determines whether they are benign or malignant. Polyps less than 10 mm in size are benign in most conditions caused by inflammation or excess cholesterol deposits. Gallbladder polyps larger than 10mm have a low risk of malignancy and are monitored carefully to check whether they grow or remain constant. Polyps greater than 18 mm in size carry malignancy risk and need to be operated.

The European Society of Gastrointestinal and Abdominal Radiology strongly recommends cholecystectomy for gallbladder polyps greater than or equal to 10mm in size. The American guidelines, in comparison, recommend no follow-ups in polyps 6mm or smaller, yearly follow- ups for polyps measuring 7-9mm, follow-ups at 6, 12, 24 and 36 months for polyps measuring 10-14 mm and surgical consultation when polyps are 15mm or larger.

What causes gallbladder polyps

gallbladder polyps are found in 4-5% of the general population and are strongly suggested to be associated with genetic changes in cell morphology.

Studies have shown that changes in specific genes result in abnormal growth of cells even when cell growth and division are not necessary. Smoking, alcohol consumption, diabetes and obesity tend to trigger the cell proliferation process, resulting in intestinal polyps. Because of their association with acidic enzymes, the colon and rectum are more prone to polyps and subsequent metabolic changes.

Clinical trials conducted on 1405 subjects with gallbladder polyps have shown fatty liver to be closely associated with the disease, irrespective of sarcopenia (age-related loss of muscle mass and strength ) and visceral obesity ( belly fat/ abdominal obesity ). Gallstones , cholecystitis ( inflammation of the gallbladder ), cholangitis ( biliary cirrhosis ), high cholesterol and Familial Adenomatous Polyposis ( hereditary tendency to form precancerous polyps in the intestine ) are other factors increasing the risk of gallbladder polyps.

Gallbladder polyps can be divided into several subcategories depending on their position and inflammatory nature.

Types of gallbladder polyps

Cholesterol Polyps

Cholesterol polyps, also called pseudopolyps, are caused by cholesterol deposits accumulating and sticking to the gallbladder wall, resulting in the formation of polyps. Pseudopolyps account for 70% of suspected gallbladder polyp occurrence and don't have the potential to be malignant or carcinogenic.

Inflammatory Polyps

Inflammatory polyps are non-cancerous growths accounting for 5-10% of gallbladder polyp cases. They are common in people with cholecystitis and biliary colic and present with symptoms of fever, abdominal pain, nausea, vomiting and jaundice tendencies.

Adenomyomatosis

Adenomyomatosis is an abnormal gallbladder lining overgrowth condition, resulting in gallbladder cysts. Though it was initially recognized as a precancerous lesion, recent studies recognize adenomyomatosis as a benign alteration of the gallbladder associated with cholecystitis and cholecystolithiasis ( gallbladder stones ).

Adenomas

Gallbladder adenomas are uncommon benign polyps that exhibit premalignant tendencies. Adenomas constitute 4-7% of gallbladder polyps and are more prevalent in the female population. Usually, adenomas are less than 2 cm with an average size of 5-20mm, as observed through ultrasound technology,

Malignant Polyps

Malignant gallbladder polyps or adenocarcinomas are high-risk polyps characterized by their large size. They have a survival rate of 5%, even after intensive surgical intervention and chemotherapies. Gallstones, age, gender and presence of chronic gallbladder inflammation are the chief causes of gallbladder adenocarcinoma. But they can be caused by lifestyle factors like smoking and obesity as well.

Symptoms of Gallbladder polyps

Gallbladder polyps are asymptomatic structures that rarely cause pain or discomfort unless they are inflammatory. Sometimes patients present with symptoms of abdominal pain that, on Ultrasound investigation look like polyps but are gallstones resembling polyps.

Occasionally the polyps obstruct the cystic duct or bile duct passageway resulting in symptoms of cholecystitis or cholangitis their proximity to the rectal margins makes them susceptible to an increased risk of colorectal adenoma, a condition characterized by polys like growth in the colon or rectum of the individual. Colorectal adenoma because of gallbladder polyps can lead to a disruption in bowel habits with constipation or diarrhea that lasts longer than a week.

Inflammatory gallbladder polyps may present with pain and abdominal nausea and need medical intervention for symptomatic relief. Diagnosing the polyps can provide a clear idea about their malignant or obstructive origin and be treated accordingly.

How to diagnose a gallbladder polyp?

Transabdominal Ultrasound

Transabdominal Ultrasound uses ultrasound waves to differentiate between polyps and no- polyps. It does not provide a reliable idea of distinguishing between pseudopolyps from actual polyps.

Endoscopic Ultrasound

Endoscopic Ultrasound has a high spatial resolution that helps differentiate between true and pseudopolyps and between adenomas and adenocarcinoma polyps.

CT scan

A CT scan can help diagnose gallbladder polyps in gallbladder cancer and provide an accurate idea about the stage of the disease. It is, however, unreliable in detecting small gallbladder polyps.

Treatment options

Periodic monitoring is the best treatment option for smaller polyps as it can give the consultant an accurate idea of whether it is malignant or benign. Usually, polyps grow less than 2mm in a year, but malignant polyps have a faster growth rate. If the polyp is detected to be malignant, then the surgeon calculates the risks and symptoms associated with it before removing the gallbladder entirely.

Can Ayurveda cure gallbladder polyp?

Ayurveda, a traditional Indian medicine system uses a holistic approach to healing. Ayurvedic treatment for gallbladder polyps may include dietary changes, herbal supplements, and massages. There is limited scientific evidence to support the use of Ayurveda for treating gallbladder polyps. However, it can effectively restore balance in the body and boosting the immune system. If you're considering using Ayurveda to treat your gallbladder polyp, it's important to speak with a qualified healthcare practitioner.

Are there any home remedies for gallbladder polyp?

Three major things you can focus upon are −

• eating a healthy diet

• maintaining a healthy weight

• exercising regularly

A high-fiber, low-fat diet can help to reduce the amount of cholesterol in the blood. This, in turn, can reduce the risk of developing gallstones. Maintaining a healthy weight is also important. The best way is to exercise regularly to keep the body fit and toned. This can also reduce the risk of developing gallstones.

Conclusion

It is possible to survive after removing the gallbladder. But long-term effects of gallbladder removal can result in diarrhea, abdominal pain, heartburn and fatty food intolerance symptoms, impacting the quality of your life. To prevent the incidence of gallbladder polyps, ensure a healthy diet that includes fruits and vegetables while avoiding smoking, fried and greasy food, processed or ready-made foods and carbonated beverages.