Chronic indigestion. Upper abdominal pain. Nausea and vomiting. These are the symptoms of gallstones, a condition that runs in families and is common in women between the ages of 20 and 60, obese individuals, and in those who lose weight suddenly.

Gallstones rarely develop in children but this can happen in the presence of an underlying disorder that leads to their formation.

Increased bilirubin (bile pigment) following sickle cell disease or hereditary spherocytosis (a condition wherein the red blood cells rupture easily) can result in stone formation. The latter is usually associated with anemia, jaundice and an enlarged spleen.

The risk of having gallstones also increases with obesity, a family history of the disease and other genetic factors. In most cases, however, the cause of gallstones is unknown and there is no specific preventive measure.

Most people with gallstones have no symptoms but others may experience colicky pain in the upper right abdomen or between the shoulder blades, bloating or belching, and intolerance for fatty foods.

"A stone may block the bile duct or cause it to spasm; this can be very painful and cause nausea, vomiting, fever and jaundice," according to Kurt Butler and Dr. Lynn Rayner of the University of Hawaii in "The Best Medicine."

For these people, surgical treatment is necessary to prevent complications like an infection or rupture of the gallbladder. But before you rush to surgery, the doctor may try other conservative measures like weight loss and a low-fat diet. Most gallstones are made of cholesterol and avoiding fatty or greasy foods may help reduce their incidence.

"About 65 percent of persons with stones have no trouble from them, and that includes those who have already had one gallbladder attack. Among those who do develop symptoms, most will improve by simply following a low-fat diet. So there is usually no need to rush to surgery. Even if the gallbladder flares up, there is almost always enough time to act. Remember that in every operation, no matter how trivial, there is some risk - from the anesthesia, an unforeseen complication during the operation, a blood clot afterward or infection. And gallbladder surgery is by no means trivial!" said Dr. Isadore Rosenfeld of the New York Hospital-Cornell Medical Center in "Second Opinion."

Another alternative to surgery involves the use of bile salt tablets to dissolve the cholesterol stones. But this works only for a few people and recurrence of stones is common even with their use.

"In other words, you've got to keep taking the medication for the rest of your life. These agents work best in women, in thin people, and when the gallbladder contains many cholesterol stones (so that there is a large surface area in contact with the drug). These drugs seem to have no effect on frequency of pain or the need for surgery," Rosenfeld said.

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