Biliary sludge is a mixture of cholesterol and calcium salts that collects in the gallbladder and does not drain effectively into the intestine. This makes bile thicker and more concentrated.

Biliary sludge typically does not cause serious health problems, but it can make digestion harder for some people. When that happens, it may feel like indigestion.

Biliary sludge can raise the risk of developing gallstones over time. In most cases, it can be managed with dietary changes, while surgery is typically considered only if the gallbladder becomes inflamed or symptoms are severe.

Main symptoms

The main symptoms of biliary sludge are:

Intense pain on the right side of the abdomen;
Nausea and vomiting;
Stool with a muddy appearance;
Loss of appetite;
Excess gas;
Abdominal bloating.

These symptoms are uncommon because biliary sludge may slow gallbladder emptying, but it rarely prevents the gallbladder from functioning. As a result, it is usually discovered incidentally during an abdominal ultrasound performed for another reason.

Therefore, it is rare for biliary sludge to lead to gallbladder inflammation and noticeable symptoms.

If biliary sludge goes unnoticed and causes no symptoms, many people make no changes to their diet. However, this can increase the risk of gallstones, as the sludge may gradually thicken and harden over time.

Is biliary sludge dangerous?

Biliary sludge itself is generally not considered dangerous.

However, its presence can increase the risk of gallstones (cholelithiasis), which can cause severe pain and complications if not treated appropriately.

Confirming a diagnosis

Biliary sludge is diagnosed by a gastroenterologist based on a physical exam and a review of symptoms.

The clinician may also order imaging tests to help confirm biliary sludge, such as an ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT scan).

Possible causes

Biliary sludge can develop when bile mixes with cholesterol and calcium salts and remains in the gallbladder for a long time.

Some factors can increase the risk of biliary sludge, such as:

Pregnancy;
Fasting for 5 to 10 days;
Very rapid weight loss;
A very low-fat diet;
Diabetes;
Overweight or obesity.

In addition, the use of medications such as ceftriaxone and octreotide, and hospital situations such as total parenteral nutrition and organ transplantation, can also increase the risk of biliary sludge.

These conditions can raise the concentration of cholesterol in bile and reduce the gallbladder’s natural contractions. Over time, this can contribute to biliary sludge formation.

Treatment options

Treatment for biliary sludge should be guided by a gastroenterologist to help prevent complications, such as gallstones.

The main treatments for biliary sludge are:

Dietary changes

Dietary changes for biliary sludge should be made under the guidance of a registered dietitian, who may suggest a balanced and varied diet, especially for individuals recovering from prolonged fasting.

A higher intake of healthy fats may also be recommended for people on very low-calorie diets or those losing weight very quickly. This can help improve gallbladder contractions and, in turn, support the elimination of biliary sludge.

However, when biliary sludge is associated with other factors and causes symptoms similar to gallstones, a registered dietitian typically recommends eating plenty of fruits, vegetables, and whole grains, such as brown rice and whole wheat bread. In these cases, limiting fat intake is also commonly advised.

Use of medications

In many cases, medication is not needed, especially when biliary sludge does not cause symptoms.

However, when symptoms occur or gallstones are present, the gastroenterologist may recommend medications such as ursodeoxycholic acid (ursodiol) to help dissolve gallstones.

Pain relievers or antiemetics may also be recommended to help relieve pain or nausea.

Surgery

Surgery is usually considered when biliary sludge causes severe symptoms or when an ultrasound also shows gallstones.

In most cases, the surgery is performed laparoscopically and aims to prevent blockage of the bile ducts. This helps reduce the risk of severe gallbladder inflammation.

Can biliary sludge be eliminated?

Biliary sludge may clear on its own when the condition that caused it resolves, such as pregnancy or rapid weight loss.

However, if biliary sludge remains even after the underlying cause has been resolved, it is not advisable to attempt to force its removal.

No available treatment has been proven effective specifically for eliminating sludge, and such efforts may only trigger symptoms like diarrhea or vomiting without actually clearing it.

Therefore, it is best to maintain a balanced, healthy diet and monitor for symptoms that may indicate gallstones, so appropriate treatment can be initiated if necessary.

Biliary Sludge: Symptoms, Causes & Treatment