How should I manage a patient with biliary colic who has recurrent episodes despite lifestyle modifications?

Management of a patient with biliary colic experiencing recurrent episodes despite lifestyle modifications:

• Refer the patient to a surgeon for consideration of laparoscopic cholecystectomy, as this is the recommended treatment for symptomatic gallbladder stones causing recurrent biliary colic.
• While awaiting surgical assessment, provide appropriate analgesia. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac are preferred for pain control and may reduce the risk of acute cholecystitis. If NSAIDs are contraindicated or insufficient, opioids like buprenorphine may be used cautiously.
• Continue to advise a low-fat diet to help prevent further biliary pain episodes, although this alone is often insufficient for recurrent symptoms.
• Urgent referral is indicated if the patient develops signs of complications such as jaundice, abnormal liver function tests, or systemic illness, which may suggest bile duct stones or acute cholecystitis.

In summary, recurrent biliary colic despite lifestyle changes warrants surgical referral for cholecystectomy, supported by analgesia and dietary advice while awaiting definitive treatment.

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