Gallbladder Sludge: An Underrecognized Precursor of Gallstones in Indian Adults

Review by Prof. Nidhi Dave (India)

Study Summary 

Gallbladder sludge is a mixture of particulate matter and bile, often found incidentally on imaging. Though asymptomatic in many, it can progress to gallstones, cholecystitis, and even pancreatitis. The clinical significance and epidemiological burden of gallbladder sludge remain underexplored, particularly in the Indian population where dietary and hormonal factors may differ from the West. Due to related hormonal effects pregnant females may be at additional risk for the development of gall bladder sludge.

This was a hospital-based study from India that prospectively evaluated pregnant women for gallbladder sludge using ultrasonography and tracked progression. The authors, thereby, assessed the prevalence and incidence of biliary sludge and gallstones during pregnancy and examined contributing factors such as hormonal changes and dietary habits.

Sludge was observed in 14.58% of pregnant Indian women. Independent risk factors included a high-fat diet, hormonal changes and a sedentary lifestyle. The study suggested regular ultrasound screening and preventive interventions in high-risk groups.

Commentary 

The strength of the study lies in its prospective design and focus on a high-risk Indian subgroup (pregnant women). However, the results may not be generalizable across genders and age groups. Gallbladder sludge could be an early warning sign of gallstone disease, particularly in populations eating a high-fat diet, who are obese, and subject to hormonal fluctuations that affect gallbladder function. The underlying mechanisms—biliary stasis, cholesterol supersaturation, and hormonal effects—are globally relevant, but regional dietary and genetic factors may influence incidence and progression.

Further multicentric Indian studies are needed to understand the progression of sludge to symptomatic disease. A public health focus on lifestyle modifications may reduce the disease burden.

Citation

1. Dubey R, Dubey P, Solanki A, Dubey H. Prevalence and incidence of biliary sludge and stones during pregnancy: A hospital-based study. Paripex - Indian Journal of Research [Internet]. 2019 [cited 2025 Jun 4];8(3):35–7. Available from: https://www.worldwidejournals.com/paripex/article/prevalence-and-incidence-of-biliary-sludge-and-stones-during-pregnancy-a-hospital-based-study/MTE5NDg%3D/?is=1

2. Medicover Hospitals. Sludge in Gallbladder - Causes, Symptoms and Treatment [Internet]. Medicover Hospitals. 2023 [cited 2025 Jun 4]. Available from: https://www.medicoverhospitals.in/diseases/sludge-in-gallbladder/

3. Vinmec International Hospital. Gallbladder sludge has few warning symptoms [Internet]. Vinmec.com. 2023 [cited 2025 Jun 4]. Available from: https://www.vinmec.com/eng/blog/gallbladder-sludge-has-few-warning-symptoms-en

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