Many cases of biliary colic can safely be managed at home.
First line treatment is a NSAID (1).
- a meta-analysis concluded that:
- NSAIDs should be considered as the first choice treatment as they control pain and significantly reduce the rate of severe complications, mainly represented by acute cholecystitis, jaundice, cholangitis and acute pancreatitis (1)
- IM administration of the NSAID diclofenac appears to be an effective initial treatment in patients with biliary colic (2)
Opioid analgesia:
- there is some study evidence that suggests that opioid analgesia is safe and effective in the treatment of patients with acute abdominal pain (3)
- note however that using opioids in patients with acute biliary colic is further complicated by the results of several studies that indicate opioids increase pressure in the cystic duct from spasm in the sphincter of Oddi (4,5)
Severe attacks usually lead to hospital admission. If the patient is fit for surgery then cholecystectomy is indicated. This is usually done electively.
If the patient is unfit for surgery then dissolution therapy with ursodeoxycholic acid may be indicated for patients with radiolucent stones less than 1.5cm in diameter and with a functioning gallbladder verified on oral cystography. There is complete dissolution in about 30% of cases at 12 months.
Reference:
- 1) Colli A et al. Non-steroid anti-inflammatory drugs for biliary colics: a metanalysis. Journal of Hepatology 2009; 50 (S1):103
- 2) Akriviadis EA et al. Treatment of biliary colic with diclofenac: A randomized, double-blind, placebo-controlled study Gastroenterology 1997; 113 (1): 225-231.
- 3) LoVecchio T et al. The use of analgesics in patients with acute abdominal pain. J Emerg Med 1997;3: 775-779.
- 4) Bird KJ. Narcotic induced choledochoduodenal sphincter spasm reversed by naloxone. Anaesthesia 1986;41:1120-1123.
- 5) Mclean ER et al. Small, Cholangiographic demonstration of relief of narcotic-induced spasm of the sphincter of Oddi. Am Surg 1982;48: 134-136.