May 25, 2024

1400H - 1500H
Via Zoom

Empowerment
objective - for laypeople
to have an essential
GALLBLADDER understanding on the
STONES – HOW EFFECTIVENESS,
EFFECTIVE AND USEFULNESS and
USEFUL ARE LIMITATIONS OF NON-
NON-SURGICAL SURGICAL TREATMENT
TREATMENT? FOR GALLBLADDER
STONES
as part of their health
management.
 May 25, 2024
1400H - 1500H
Via Zoom
Welcome all!
Empowerment
MUTE yourself but always
objective - for laypeople
show your video picture.
to have an essential
GALLBLADDER understanding on the Sign in your name, FB
account, or email address in
STONES – HOW EFFECTIVENESS,
the Chat Box! Include names
EFFECTIVE AND USEFULNESS and of companions attending.
USEFUL ARE LIMITATIONS OF NON-
Use the Chat Box to ask
NON-SURGICAL SURGICAL TREATMENT
questions and make
TREATMENT? FOR GALLBLADDER comments while the PEP TALK
STONES is on.
as part of their health
There will be group pictures
management. at start and end of PEP TALK –
show your face in video.
Reminder after the PEP
Talk:

Take the Online Learning

cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.

Link is in Chat Box.

Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.
 Empowerment ROJOSON’S REQUEST:
objective - for laypeople
to have an essential FEEDBACK TO THIS
GALLBLADDER understanding on the PEP TALK!
STONES – HOW EFFECTIVENESS,
EFFECTIVE AND USEFULNESS and Pls. type in your
USEFUL ARE LIMITATIONS OF NON- feedback in the chat
NON-SURGICAL SURGICAL TREATMENT box during the open
TREATMENT? FOR GALLBLADDER forum and before we
STONES adjourn!
as part of their health
management. Thank you!
 LET’S NOW HAVE A
Empowerment
GROUP PICTURE
objective - for laypeople
TAKING BEFORE WE
to have an essential
START PEP TALK
GALLBLADDER understanding on the
PROPER IN 2
STONES – HOW EFFECTIVENESS,
MINUTES!
EFFECTIVE AND USEFULNESS and
USEFUL ARE LIMITATIONS OF NON-
Pls. turn on your
NON-SURGICAL SURGICAL TREATMENT
video!
TREATMENT? FOR GALLBLADDER
Show your face!
STONES
as part of their health
management.
 Empowerment
objective - for laypeople ROJoson PEP Talk
to have an essential
GALLBLADDER understanding on the I have a Patient
STONES – HOW EFFECTIVENESS, Empowerment
EFFECTIVE AND USEFULNESS and Program in which I
USEFUL ARE LIMITATIONS OF NON- like to empower the
NON-SURGICAL SURGICAL TREATMENT lay people or
TREATMENT? FOR GALLBLADDER patients to take
STONES control in the
as part of their health management of
management. their health.
I started the PEP Talk
on May 15, 2021
during the COVID19
Pandemic. There are
3 courses in the PEP
Talk. I completed the
Core Course on
October 9, 2021.
 From October 23, 2021
onwards, I have been
tackling Health Disorder
and Health Issue Courses.
May 18, 2024 marks the
start of YEAR 4 of
ROJoson PEP Talk.
How long the PEP Talk
will last will depend on
our enthusiasm,
discipline and
perseverance.
 L

Empowerment
My PEP TALK today is
objective - for laypeople
entitled:
to have an essential
GALLBLADDER understanding on the GALLBLADDER
STONES – HOW EFFECTIVENESS, STONES – HOW
EFFECTIVE AND USEFULNESS and EFFECTIVE AND
USEFUL ARE LIMITATIONS OF NON- USEFUL ARE NON-
NON-SURGICAL SURGICAL TREATMENT SURGICAL
TREATMENT? FOR GALLBLADDER TREATMENT?
STONES
as part of their health
management.
 GALLBLADDER Contents Disclaimer:
STONES – HOW • What are gallstones or gallbladder stones?
EFFECTIVE AND • What are the different types of gallstones? ROJoson PEP Talk
• What are the causes of gallstones?
USEFUL ARE contains ROJoson’s
• Do all patients with gallstones have symptoms?
NON-SURGICAL • Do all patients with gallstones need treatment? Thoughts,
TREATMENT? • What are the commonly heard non-surgical treatment Perceptions,
for gallstones? Opinions and
• How effective and useful and what are the limitations of Recommendations
non-surgical treatment?
• What are the advice on non-surgical treatment for (TPORs) culled from
gallstones? experiences of
ROJoson and
writings of other
health professionals.
 GALLBLADDER What are gallstones or gallbladder
STONES – HOW stones?
EFFECTIVE AND
USEFUL ARE Gallstones are hardened, concentrated
NON-SURGICAL pieces of BILE that form in gallbladder
TREATMENT? or bile ducts.

“Gall” means bile, so gallstones are

bile stones. Gallbladder is the bile
bladder. It holds and stores bile for
later use. The liver makes bile, and the
bile ducts carry it to the different
organs through the biliary tract. https://my.clevelandclinic.org/health/diseases/7313-
gallstones
 GALLBLADDER What are gallstones or gallbladder
STONES – HOW stones?
EFFECTIVE AND
USEFUL ARE Gallstones form when bile sediment
NON-SURGICAL collects and crystallizes. Often, the
TREATMENT? sediment is an excess of one of the
main ingredients in bile.

https://my.clevelandclinic.org/health/diseases/7313-
gallstones
 GALLBLADDER What are the different types of gallstones?
STONES – HOW
EFFECTIVE AND • Cholesterol stones
USEFUL ARE
NON-SURGICAL • Pigment stones
TREATMENT?
• Mixed stones with calcium salts – most
common in the Philippines
 GALLBLADDER What causes gallstones?
STONES – HOW
EFFECTIVE AND Gallstones may form if bile contains too much
USEFUL ARE cholesterol, too much bilirubin, or not enough
NON-SURGICAL bile salts.
TREATMENT?
Researchers do not fully understand why these
changes in bile occur.
https://www.niddk.nih.gov/
health-information/digestive-
Gallstones also may form if the gallbladder does diseases/gallstones/symptoms-
not empty completely or often enough. causes#:~:text=Gallstones
%20may%20form%20if
%20bile,empty%20completely
%20or%20often%20enough.
 GALLBLADDER What causes gallstones?
STONES – HOW
EFFECTIVE AND Gallstones are thought to develop because of an
USEFUL ARE IMBALANCE in the chemical make-up of bile
NON-SURGICAL inside the gallbladder. The exact cause of the
TREATMENT? imbalance is not known.

Gallstones form when there’s an excess of one of

the main ingredients in bile.

The excess ingredient turns to sediment at the

bottom of your gallbladder or bile ducts, and the
https://my.clevelandclinic.org/
sediment gradually hardens into stones. health/diseases/7313-gallstones
 GALLBLADDER Do all patients with gallstones have symptoms?
STONES – HOW
EFFECTIVE AND Gallstones can be asymptomatic or symptomatic
USEFUL ARE (with symptoms, particularly pain at the right
NON-SURGICAL upper quadrant of the abdomen).
TREATMENT?
 t
GALLBLADDER Do all patients with gallstones need treatment?
STONES – HOW
EFFECTIVE AND If the gallstones never cause problems, NO
USEFUL ARE treatment is needed. If they are causing pain,
NON-SURGICAL treatment is needed.
TREATMENT?
If gallstones cause a blockage in the biliary tract,
the blockage have to be remedied — not just the
blockage, but all of them (gallstones).

Once gallstones have caused a blockage, they’re

highly likely to do so again.
https://my.clevelandclinic.org/
health/diseases/7313-gallstones
 GALLBLADDER Do all patients with gallstones need treatment?
STONES – HOW
EFFECTIVE AND The question is:
Most people who need treatment for gallstones
USEFUL ARE HOW EFFECTIVE AND
will have surgery to remove them. SURGERY IS
NON-SURGICAL USEFUL ARE THE
THE ONLY WAY TO ENSURE GALLSTONES WON’T
TREATMENT? NON-SURGICAL
CAUSE ISSUES AGAIN.
TREATMENT FOR
GALLSTONES?
But if you can’t or don’t want to have surgery, it
is said there are some alternative treatments to
Our main topic /
try, including medications and other procedures.
issue for discussion in
this PEP Talk!
https://my.clevelandclinic.org/
health/diseases/7313-gallstones
 ive
GALLBLADDER What are the commonly heard non-surgical
STONES – HOW treatment for gallstones?
EFFECTIVE AND The question is:
USEFUL ARE - HOW EFFECTIVE AND
Observation
NON-SURGICAL - USEFUL ARE THE
Gallbladder cleanse or flushing
TREATMENT? - NON-SURGICAL
Medications
- TREATMENT FOR
Avoidance of fatty foods
GALLSTONES?

Our main topic /

issue for discussion in
this PEP Talk!
 GALLBLADDER What are the commonly heard non-surgical Observation
STONES – HOW treatment for gallstones? is the
EFFECTIVE AND recommendation if
USEFUL ARE Observation there are NO
NON-SURGICAL - The risks of developing symptoms or complications symptoms associated
TREATMENT? from gallstones in patients who have no symptoms is with the gallstones
on the order of 20% over 20 years. Thus, patients who
because it is believed
are older than 40 years of age and have no other
indications for gallbladder treatment can be observed. that gallbladder
Although there is a risk of having an attack at an cleansing or flushing
inopportune time or developing one of the and medications are
complications, this is small. However, patients with not effective or cost-
symptoms should consider treatment.
effective.
https://www.lifespan.org/centers-services/general-and-
gastrointestinal-surgery/about-gallstones/non-surgical-treatments
 GALLBLADDER What are the commonly heard non-surgical Observation
STONES – HOW treatment for gallstones? is the
EFFECTIVE AND recommendation if
USEFUL ARE Observation there are NO
NON-SURGICAL - Observation is recommended for patients with symptoms associated
TREATMENT? asymptomatic gallstones. with the gallstones
- As only about 4% of patients with because it is believed
asymptomatic gallstones develop symptoms that gallbladder
including cholecystitis, obstructive jaundice, cleansing or flushing
pancreatitis, and gallbladder cancer. and medications are
not effective or cost-
effective.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923050/#:~:text=Cholecystectomy%20is
%20currently%20advised%20only,%2C%20pancreatitis%2C%20and%20gallbladder%20cancer.
 GALLBLADDER What are the commonly heard non-surgical Observation
STONES – HOW treatment for gallstones? is the
EFFECTIVE AND recommendation if
USEFUL ARE Observation there are NO
NON-SURGICAL - Observation is recommended for patients with symptoms associated
TREATMENT? asymptomatic gallstones. with the gallstones
- Patients developed symptoms at a rate of because it is believed
approximately 1% to 2% per year. Complications were that gallbladder
rare (approximately 4% over 25 years) except when
cleansing or flushing
preceded by biliary colic. Complications typically
include acute cholecystitis (0.3% per year), obstructive and medications are
jaundice (0.2% per year), acute pancreatitis (0.04% to not effective or cost-
1.5% per year), and gallstone ileus (rare). effective.
https://www.aafp.org/pubs/afp/issues/2014/0315/p468.html#:~:text=Complications%20were
%20rare%20(approximately%204,and%20gallstone%20ileus%20(rare).
 s
GALLBLADDER What are the commonly heard non-surgical Observation
STONES – HOW treatment for gallstones? is the
EFFECTIVE AND recommendation if
USEFUL ARE Observation there are NO
NON-SURGICAL - Observation is the best form of therapy for symptoms associated
TREATMENT? patients with asymptomatic gallstones. with the gallstones
- Surgical management offers the least risk and because it is believed
greatest benefit to patients with symptomatic that gallbladder
gallstones. cleansing or flushing
- Gallbladder cleansing / flushing are and medications are
ineffective. not effective or cost-
- Medication – dissolution therapy is not cost- effective.
effective.
https://pubmed.ncbi.nlm.nih.gov/3945594/
 GALLBLADDER What are the commonly heard non-surgical
STONES – HOW treatment for gallstones?
EFFECTIVE AND
USEFUL ARE Medicines to dissolve the gallstones
NON-SURGICAL • There are medicines in the market
TREATMENT? (particularly, URODEOXYCHOLIC ACID)
commonly prescribed by physicians for
patients with gallstones.
• These are expensive (about P50 / cap) and
these are usually taken 3 x a day for 6 to 12
months (minimum of 3 months).
 GALLBLADDER What are the commonly heard non-surgical
STONES – HOW treatment for gallstones?
EFFECTIVE AND
USEFUL ARE Medicines to dissolve the gallstones
NON-SURGICAL • The drug works only in patients who have
TREATMENT? cholesterol or primarily cholesterol stones.
• Majority of gallstones in the Philippines are
mixed stones.

https://www.lifespan.org/centers-services/general-and-
gastrointestinal-surgery/about-gallstones/non-surgical-treatments
 GALLBLADDER Conclusion:
What are the commonly heard non-surgical
STONES – HOW It is not cost-effective
treatment for gallstones?
EFFECTIVE AND to take dissolution
USEFUL ARE therapy
Medicines to dissolve the gallstones
NON-SURGICAL (urodeoxycholic acid)
• Patients with cholesterol gallstones who take
TREATMENT? for gallstones.
the drug for two years have a 20% chance of
having their gallstones dissolved.
It can take months or
• These patients need to continue taking once
years for all of the
per day after the stones dissolve since their
gallstones to break
gallbladder remains diseased and there is a 30
up.
to 50% chance of recurrence of gallstones in 3
There is recurrence.
to 5 years without further treatment.
https://www.lifespan.org/centers-services/general-and-
gastrointestinal-surgery/about-gallstones/non-surgical-treatments
 GALLBLADDER What are the commonly heard non-surgical treatment for gallstones?
STONES – HOW
Gallbladder Cleanse or Flushing
EFFECTIVE AND
Gallbladder Cleanse Myths
USEFUL ARE If you see a gallbladder cleanse promoted, it most likely encourages you to eat
NON-SURGICAL or drink olive oil in combination with a particular fruit juice over a certain
TREATMENT? period of time. Claims include that these ingredients break up gallstones in
your gallbladder and stimulate your body to pass them in your stool when you
use the bathroom.

Olive oil does have laxative properties, but there is no proof that it has an
impact on gallstones. If you look at your stool following an olive oil cleanse,
you may see lumps in your stool that you suspect are gallstones. Instead, they
are GLOBS of olive oil, juice, and other food from your digestive tract.
https://www.webmd.com/digestive-disorders/what-is-a-gallbladder-
cleanse
 GALLBLADDER Gallbladder Cleanse or Flushing
STONES – HOW Using apple / apple juice, Epsom salt, olive oil, lemon juice
EFFECTIVE AND First five days
USEFUL ARE You can eat 4-5 apples or drink 4 glasses of apple juice for the first five days.
NON-SURGICAL Sixth day –
TREATMENT? Skip your evening meal. Instead, you have to drink a big cup of warm water along with a
teaspoon of Epsom salt mixed in it. Repeat this process again after 1.5 hours. This will aid in
releasing the gallstones.
With your second drink of warm water and Epsom salt, you can try various combinations for
proper lubrication that will help in releasing the bladder stones out of your bladder. You can
add a tablespoon of sesame oil or olive oil in this drink. Else, you can mix lemon juice of a
whole lemon in this drink.
Seventh-day
You will have your bowel movement. You will observe stones with a greenish tint in your
stools.
https://www.pristyncare.com/blog/apple-juice-for-gallstones-
removal-naturally-pc0113/
 GALLBLADDER What are the commonly heard non-surgical
STONES – HOW treatment for gallstones?
EFFECTIVE AND
USEFUL ARE Avoiding fatty foods won't prevent or get rid of
NON-SURGICAL gallstones, but it may reduce the frequency of
TREATMENT? attacks.

https://www.health.harvard.edu/womens-health/what-to-do-about-
gallstones
 GALLBLADDER What are the commonly heard non-surgical
STONES – HOW treatment for gallstones?
EFFECTIVE AND
USEFUL ARE Changing your diet won't get rid of gallstones that
NON-SURGICAL are already there, but eating a healthy, balanced
TREATMENT? variety of nutrients and limiting the amount of
saturated fats and cholesterol-heavy food you eat
may help ease your symptoms.

https://www.webmd.com/digestive-disorders/features/gallbladder-
diet-foods-for-gallbadder-problems
 one
GALLBLADDER What are the commonly heard non-surgical
STONES – HOW treatment for gallstones?
EFFECTIVE AND
USEFUL ARE Lithotripsy
NON-SURGICAL
TREATMENT? Lithotripsy, or shock wave dissolution of
gallstones, is a technique that uses a highly
focused sound wave to break the stones up into
tiny particles that can then pass through the
cystic duct into the common duct and out into
the intestine.

https://www.lifespan.org/centers-services/general-and-
gastrointestinal-surgery/about-gallstones/non-surgical-treatments
 in
GALLBLADDER What are the commonly heard non-surgical
STONES – HOW treatment for gallstones?
EFFECTIVE AND
USEFUL ARE Lithotripsy
NON-SURGICAL
TREATMENT? Can be used for small single stones (not more
than 2cm).

Gallstones may recur – high incidence.

 GALLBLADDER What are the advice on non-surgical treatment for gallstones?
STONES – HOW
EFFECTIVE AND For asymptomatic gallstones, just observe. Avoid fatty foods.
USEFUL ARE
NON-SURGICAL For symptomatic gallstones, go for surgery to remove the whole
TREATMENT? gallbladder with the stones.

Do not go for gallbladder cleanse and flushing as it is not effective.

Do not go for oral dissolution medications (such as urodeoxycholic acid)
as it is not cost-effective.

If you do not want surgery, eat healthy diet, exercise, avoid fatty foods,
drink a lot of water and hang-on.
 t
GALLBLADDER Contents Summary
STONES – HOW • What are gallstones or gallbladder stones?
EFFECTIVE AND • What are the different types of gallstones? Take Away
• What are the causes of gallstones?
USEFUL ARE
• Do all patients with gallstones have symptoms?
NON-SURGICAL • Do all patients with gallstones need treatment?
TREATMENT? • What are the commonly heard non-surgical treatment
for gallstones?
• How effective and useful and what are the limitations of
non-surgical treatment?
• What are the advice on non-surgical treatment for
gallstones?
 GALLBLADDER Be always in touch with reliable medical
information on EFFECTIVENESS, USEFULNESS AND
Take Away in
STONES – HOW
EFFECTIVE AND LIMITATIONS OF NON-SURGICAL TREATMENT ON relation to
USEFUL ARE GALLBLADDER STONES. Patient
NON-SURGICAL Empowerment
Knowledge is power; it gives power.
TREATMENT?
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan to gain greater control over
decisions / make better decisions on
EFFECTIVENESS, USEFULNESS AND LIMITATIONS
OF NON-SURGICAL TREATMENT ON
GALLBLADDER STONES as part of your health
management.
 Empowerment
This ends my PEP
objective - for laypeople
TALK today on:
to have an essential
GALLBLADDER understanding on the GALLBLADDER
STONES – HOW EFFECTIVENESS, STONES – HOW
EFFECTIVE AND USEFULNESS and EFFECTIVE AND
USEFUL ARE LIMITATIONS OF NON- USEFUL ARE NON-
NON-SURGICAL SURGICAL TREATMENT SURGICAL
TREATMENT? FOR GALLBLADDER TREATMENT?
STONES
as part of their health
management.
Reminder after the PEP
Talk:

Take the Online Learning

cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.

Link is in Chat Box.

Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.
 Empowerment ROJOSON’S REQUEST:
objective - for laypeople
to have an essential FEEDBACK TO THIS
GALLBLADDER understanding on the PEP TALK!
STONES – HOW EFFECTIVENESS,
EFFECTIVE AND USEFULNESS and Pls. type in your
USEFUL ARE LIMITATIONS OF NON- feedback in the chat
NON-SURGICAL SURGICAL TREATMENT box during the open
TREATMENT? FOR GALLBLADDER forum and before we
STONES adjourn!
as part of their health
management. Thank you!
 LET’S NOW HAVE A
Empowerment
GROUP PICTURE
objective - for laypeople
TAKING BEFORE WE
to have an essential
START Q&A AND
GALLBLADDER understanding on the
INTERACTIONS!
STONES – HOW EFFECTIVENESS,
EFFECTIVE AND USEFULNESS and
Pls. turn on your
USEFUL ARE LIMITATIONS OF NON-
video!
NON-SURGICAL SURGICAL TREATMENT
Show your face!
TREATMENT? FOR GALLBLADDER
STONES
as part of their health
management.