What to Know About Gallstones When You Have Crohn’s Disease

“Classically, Crohn’s will target the last portion of the small intestine known as the terminal ileum,” says Nour A. Parsa, MD, a gastroenterologist at Loma Linda University Health in California. “This is where bile acids, which are made in the liver, are primarily absorbed.”

During normal metabolism (breakdown) of food, bile salts and bile acids break up fat, and bilirubin (a waste product made from the breakdown of red blood cells) gives bile and stool their yellowish brown color. If your bile contains too much bilirubin or cholesterol, the excess becomes sediment that can harden into gallstones. If your Crohn’s affects the terminal ileum, the inflamed, diseased ileum fails to absorb bile salts, which are expelled with your bowel movements, leaving you without enough raw material to make adequate bile to digest food well.

“When bile salts and bile acids are not effectively reabsorbed, binding of cholesterol can be affected and lead to cholesterol gallstone formation,” says Suneeta Krishnareddy, MD, a gastroenterologist at Columbia University Irving Medical Center in New York City.

Other risk factors for gallstone formation in people with Crohn’s disease include a history of small bowel surgical resection, which increases the risk of malabsorption, receiving total parenteral (intravenous) nutrition (TPN), and altered gallbladder motility, Dr. Parsa says.

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