There is little evidence that belching, heartburn, bloating, excessive gas, constipation and diarrhea arise from gallbladder problems [1,3,4,5,7,8]. These symptoms more likely result from gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), slow gastric emptying, nutrient intolerance or gastrointestinal infection, which can co-exist with a gallbladder disease (see Chart 1 and 2).
Rarely, a gallstone can obstruct the common bile duct or pancreatic duct and blocks the delivery of the bile or pancreatic enzymes into the intestine. This results in maldigestion and malabsorption of the nutrients and subsequently their consumption by the normal intestinal bacteria, which produce gas.
How can you tell that symptoms arise from the gallbladder?
Even a doctor cannot reliably make a diagnosis of a gallbladder disease just from the symptoms and physical examination. However, two typical symptoms associated with gallbladder problems (gallstones, biliary sludge, gallbladder inflammation, biliary dyskinesia) are :
- Recurrent pain in the right upper abdominal quadrant, which can radiate to the right middle back or to the tip of the right shoulder blade
- Nausea or vomiting, which comes and goes with pain
If you do not have recurrent right upper abdominal pain, your other symptoms, like abdominal bloating, do not likely arise from the gallbladder. Even if you have gallstones, ask for appropriate investigations, like upper endoscopy and breath tests to check for common conditions that can cause gas, like H. pylori infection of the stomach, or lactose intolerance (Chart 2), before considering gallbladder removal.
Chart 1. Belching – Common Causes
|Air swallowing (fast eating, hyperventilation)|
|Drinking carbonated beverages|
|Chronic gastritis (H. pylori infection)||Blood or stool test for H. pylori|
|Hiatus hernia (in obesity, repeated coughing or straining)||Barium swallow test|
|Gastroparesis with small intestinal bacterial overgrowth – SIBO (in diabetes mellitus, hypothyroidism)||Gastric emptying test, breath test with lactulose|
Chart 2. Bloating and Flatulence – Common Causes
|High intake of soluble fiber (oats, barley, legumes, sweet potatoes, pears, prunes, artichokes)|
|Irritable bowel syndrome (IBS)|
|Lactose intolerance (milk, yogurt, sweet stout, whey powder)||Lactose-free diet for 4 days; breath test with lactose|
|Fructose malabsorption (fructose, sorbitol, honey, apples, pears, mangoes, honey, sugar-free gum)||Low-fructose or low-FODMAP diet for 4 days; breath test with fructose|
|Intestinal parasites (Giardia, tapeworms)||Stool test for parasites|
|Pancreatic insufficiency (severe chronic pancreatitis, cystic fibrosis)||Pancreatic function tests; fecal fat test|
|Celiac disease||Gluten-free diet for a couple of months; upper endoscopy|
|Intestinal obstruction (adhesions, strictures, after surgery) with small intestinal bacterial overgrowth -SIBO||X-ray; breath test with lactulose|
|Small intestinal wall infiltration (lymphoma, amyloidosis, scleroderma)||Upper endoscopy, capsule endoscopy|
Trapped wind refers to a pocket of gas in the part of the colon near the gallbladder and liver. The gas can cause recurrent pain and tenderness in the right upper abdomen, also known as hepatic flexure syndrome. The pain remains constant for several hours and can be similar to gallbladder-related pain. The pain may or may not be associated with abdominal distension and cannot be relieved by burping or passing gas. Such “gas pain” usually has nothing with the gallbladder problems; it is more likely a part of irritable bowel syndrome (IBS).
- Heuman DM, Emedicine
- Intestinal Gas (Belching, Bloating, Flatulence) MedicineNet
- Gallstones and gallbladder disease University of Maryland, Medical Center
- Egbert AM, 1991, Gallstone symptoms. Myth and reality PubMed
- Talley NJ et al, 1995, Gallstones and upper abdominal discomfort. Innocent bystander or a cause of dyspepsia? PubMed
- Gallstones: Symptoms, diagnosis and treatment Harvard Health Publications
- Gallstones & Gallbladder Disease Cedars-Sinai
- Diehl AK, 1992, Symptoms of gallstone disease PubMed