Thursday, June 26, 2008

Lyme and the gallbladder

This an area of Lyme medicine which deserves more attention. Many Lyme patients end up with removal of the gallbladder. Lyme can infect the wall of the gallbladder and cause chronic inflammation. This appears to happen with increased frequency when there is also evidence of Salmonella infection. In the past most gallbladder disease was related to gall stones. There has been a change. Most patients with gallbladder disease no longer have stones; they have chronic inflammation of the gallbladder. Patients with gallbladder disease have recurrent bouts of abdominal pain which starts out mild but gradually builds up to severe pain. The pain may be located in the right upper abdomen or be generalized to the entire abdomen. Nausea and vomiting may occur. In the past doctors have ordered a sonogram to evaluated the gallbladder. When the problem is related to infection this test will be normal. The diagnosis is made with a nuclear medicine scan called a HIDA scan, with the administration of a hormone called CCK. The hormone injection will likely cause the symptoms to recur and the test will showed a low ejection fraction, indicating abnormal functioning of the gallbladder. Generally, successful treatment requires removal of the gallbladder which can be done with a minimally invasive laparoscope. The fact that intravenous Rocephin is known to cause gallbladder attacks may suggest that this is a sort of Herxheimer reaction involving a gallbladder which is already infected with Lyme bacteria.

13 comments:

fromvirginia said...

My daughter's HIDA scan showed her gallbladder was functioning at only 15% (she has Lyme & Bartonella, also salmonella). Her doctor prescibed actigall (ursodiol) to try to save her gallbladder. But based on what you have written, it sounds like that will be useless - if her gallbladder problems are due to inflammation and not gallstones. Is this correct?

Lyme report: Montgomery County, MD said...

Good question. There is a gallbladder/blood barrier. Antibiotics penetrate poorly into and infected gallbladder. The GB can act as a resevoir of chronic infection, adding to the difficulty of treating Lyme. Some patients immediately feel less toxic when the GB is removed since a major source of germs is gone. Actigall reduces the viscosity of bile (it makes it thinner). Some docs use it with Rocephin to prevent sludging and gallbladder attacks. If your daughter has painfull gall bladder attacks she clearly needs the GB removed. If the CCK injection given with the HIDA scan reproduced her symptoms it is clear evidence that she has a bad gallbladder. Some patients may get better with intensive antibiotic regimens without removing the gallbladder. It makes Lyme therapy more difficult. The infection resides in the wall of the gallbadder, not in the bile. There is no scientific basis for the use of Actigall for an infected gallbladder. Actigall has been used at times to dissolve gallstones, but is marginally effective. A well know Lyme MD had her gallbadder removed and a lab was able to prove Lyme (Borrelia) in the GB wall by PCR. I don't think Bartonella is an issue. Salmonella is a hardy germ with a thick cell wall that burrows into the gut wall. It also has a liking for the GB wall. Over and over I have found that Lyme/Gallbladder patients also have high antibodies to Salmonella. A long winded answer, but I believe for the most part you are correct. If her symptoms are not an issue antibiotics can be tried, but the Actgall will be of no value in my humble? opinion. I know--all of us doctors are arrogant. You got to be a little arrogant to take on the whole medical community. Your doc is well intentioned, but I think wrong. Good luck.

fromvirginia said...

Thank you. I know I speak for many when I say that I appreciate doctors like you who go against the mainstream medical community in order to help patients who are suffering. Again, thanks!

Joanne said...

I had gall bladder problems long before I had debilitating arthritis and muscle weakness. I had 2 scans and there were no gall stones.Eventually I was diagnosed with Lyme Disease. Amoxycillin has been particularly good for arthritis and muscle weakness but not for gall bladder pain especially after eating fatty food. When I was on Doxycycline and again now on Clarithromycin (with Amoxycilin) for sinus/throat infection, I find gall bladder pain is easier.
It is not bad enough to consider surgery.
What antibiotic is likely to be most effective on Lyme in the gall bladder?

Medical Information said...

Gall bladder cancer is a rare cancer. It is rarely found among below fifty age. And it is mostly found in females then males. The reason behind this cancer is not very much clear. Person suffering from it, feels sick, fever, yellowing of skin, scratchy skin etc. If anyone feels such symptoms should immediately go to doctor because mostly this cancer is detected in last stage. For more information on gall bladder cancer, refer Gall bladder symptoms

The Flour Garden said...

My husband is being treated for Lyme. He has been on both Rocephan IV and Claforan IV. And Zithromaz. The Rocephan definitely shows improvement but his liver enzymes go up drastically. Will Actigall help alleviate that?

KarenBH said...

I realize this post is several years old, but my daughter has pain in the gallbladder area that has been her most marked symptom since her journey with illness began five years ago.
She is currently being treated for Lyme disease with oral antibiotics. She has had many Herxheimer Reactions and we actually thought she was beginning to turn the corner recently until last night.
She once again developed significantly more nausea than normal, and the pain in this very specific spot in her upper right quadrant, just below the rib cage became overwhelming. The pain is radiating around to her back. She vomited twice last night and the pain has not subsided. She has had numerous ultrasounds of her gallbladder, and she had a HIDA scan four years ago (but before the pain was daily).
I suspect she is currently having a gallbladder attack, but not sure how to get this taken seriously. Would a repeat HIDA scan show damage or disfunction now that the pain is daily? I believe her gallbladder is the center of her illness and must be housing the Lyme bacteria. While I don't expect she will get completely better by removing her gallbladder, would it help? What can I say or do to get this addressed properly? Does she need to go the emergency room?

Kurt said...

I have experienced gallbladder pain throught my Lyme course, both before and after antibiotic treatment began 5 months ago. An ultrasound found nothing. I had (by far) my worst Herxheimer reaction several hours after the intake of several glasses of pure cranberry juice while taking Ceftin. After several weeks of constant cranberry juice, my gallbladder pain has subsided. May not be cause and effect, but this was my experience.

Jared said...

Hello Doctor, do you believe there is any benefit from taking Chinese herbs to treat gallbladder symptoms without stones? I read an article at http://goodbyelyme.com/free-articles/healing-pain/gallbladder_herbs that mentioned certain anti-spirochetal herbs that are intended to purge the gallbladder. Any thoughts?

Regan Allen said...

I just had my gb out 2 days ago due to Lyme. I have only been on oral abx. Doxy and Amoxicillin and never had problems with my gb until like a month ago (after 4 months of treatment). It got so bad and the sonogram never found anything wrong. Even with the HIDA they weren't absolutely sure it was the problem! I opted to have it out based on some things I'd read and that my doctor originally thought it was a gb problem. Thank God those awful attacks have stopped!

Kim_Burns said...

Informative. Me and my alternative treatments to cancer center appreciates this so much! Keep sharing!

ADB said...

My gallbladder story verbatim . Numerous ultrasound over a five year period showed nothing wrong. Finally had a HIDA scan which showed my gallbladder was functioning at 3%. Was finally diagnosed with Lyme five months later

TimFezz99 said...

Hmmm this is all very interesting!

Would a Lyme Gallbladder cause pain like others have described and light coloured stools? and maybe darker urine related also?
I have been having similar pains myself.

many thanks
Tim