Biliary colic is the most important symptom of those suffering from biliary stones or cholelithiasis, or the presence of stones, generally formed by cholesterol, which wedge into the bile ducts. In particular, the spasm of the gallbladder is more acute in the presence of a stone in the choledocyte, the main bile duct. It generally occurs at night and more frequently after eating large meals, especially if rich in fat.

About 8% of Italians suffer from it without symptoms or pain. Dr. Paolo Omodei, head of the Gastroenterology section of Humanitas, talked about it in an interview.

How to recognize a biliary colic

Biliary colic occurs with acute and intermittent pains, which can recur several times over several hours, interspersed with moments of quiet. They are distinguished from renal colic, whose pain is descending, because the pain migrates upwards, the back and the region under the scapula and right shoulder.

“The most characteristic symptom is the acute and sudden pain in the upper abdomen and in the middle, to the right, just below the ribs,” explained Omodei. “The pain often tends to extend to the right side and back to the shoulder and scapula. Painful cramps are caused by the passage of stones into the cystic duct and the coledocoum, which are part of the system of ducts that carry the bile to the intestine. Sometimes colic can also be accompanied by fever, nausea and vomiting, symptoms that may spy on further complications,” he concluded.

What are the other complications of gallbladder stones?

After colic, the most frequent consequence is acute cholecystitis, i.e. inflammation of the gallbladder wall. “The pain felt is similar to that of colic, but more persistent,” explained Omodei, to which we can add the fever “a sign of an inflammatory process that must be sedated promptly so as not to risk the development of an abscess or even perfume the gallbladder,” added the gastroenterologist.

The most feared consequence is certainly the acute pancreatitis, which is determined by the migration of a calculus from the gallbladder. “In these cases the pain is so strong that those who suffer from it ask for help from the Emergency Room. If, in addition to the typical pain of colic, there is also a yellowish coloration of the skin of the sclerae of the eyes, it is likely that we are in the presence of an obstructive jaundice,” said Omodei.

The diagnosis

First of all, an abdominal ultrasound is carried out to highlight “the stones, usually made up of cholesterol or, in rare cases, of calcium bilirubin”. In some cases, blood tests are also performed, as some parameters may be altered such as transaminases, lipases or amylases, indicating an acute pancreatic condition.


In the most acute phases of pain, after consulting the doctor, “non-steroidal or antispasmodic anti-inflammatory drugs are used. If, on the other hand, there is cholecystitis and an inflammation of the biliary tract is suspected, antibiotic treatment will be necessary,” explained Omodei.

The definitive solution for those who have suffered several times from colic and complications is cholecystectomy, or a surgical removal of the gallbladder.