[Kim So-hyung] In the summer, severe abdominal pain and indigestion that follow a short-term diet or a sudden high-fat meal should not simply be dismissed as a minor stomach upset
They may be signs of gallstones
Gallstones are a disease that affects older adults disproportionately, with more than half of all patients being in their 60s or older. However, the overall number of patients has been steadily rising in recent years. According to data from the Health Insurance Review & Assessment Service (HIRA), the number of domestic gallstone patients who visited medical facilities rose from 192,551 in 2018 to more than 200,000 for the first time in 2019, and reached about 286,700 in 2025. That means the number of patients increased by roughly 49% over seven years.
In particular, a trend of rising summer cases among younger patients has recently emerged. Over the past three years, a comparison of the average monthly increase in patient numbers from June to July-August showed gains of 8.4% among people in their 20s and 30s, and 9.4% among those in their 40s and 50s. Those figures are 1.5 times and 1.7 times, respectively, the 5.6% average increase seen among patients aged 60 and older during the same period
Experts point to summer lifestyle habits as one of the reasons behind the increase in gallstones among people in their 20s to 50s
Park Kwan-tae, a surgeon at the Hepatobiliary, Pancreatic and Vascular Center at St. Peter’s General Hospital, said, “Gallstones are influenced by a range of factors, including obesity, diet and rapid weight loss.” He added, “In summer especially, short-term dieting, irregular meals and extreme dietary restrictions become more common, which can raise the risk of gallstones among younger people.”
◇Extreme summer weight loss and restrictive diets raise gallstone risk
Gallstones are formed when residue in bile settles and hardens into stone-like deposits in the gallbladder or bile ducts. The liver produces about 750 mL of bile every day, and bile is made up of cholesterol, fat, bile salts, proteins and bilirubin. When the balance of these components changes, residue can form in the gallbladder and stones may develop
Among them, cholesterol stones, which occur because of excess cholesterol in bile, are the most common type. Because cholesterol stones are also closely linked to obesity and diets heavy in meat and high-fat foods, younger people should be careful as well. In addition, the female hormone estrogen raises cholesterol levels in bile, so women should be especially cautious
Park noted, “Rapid weight loss over a short period and severe meal restriction can reduce gallbladder function and easily trigger stone formation.” Rapid weight loss through GLP-1 drugs, which are being used more often these days, is also being analyzed as being linked to a higher risk of gallbladder diseases, including gallstones. In addition, extreme fasting and ultra-low-fat or ultra-low-calorie diets reduce gallbladder contraction, creating an environment in which bile can stagnate more easily.
The best way to prevent gallstones is to maintain regular exercise and healthy eating habits. In particular, prolonged fasting and extreme dieting for summer weight loss should be avoided as much as possible, and weight loss should be done slowly over time. People with a family history of gallstones, those with obesity, and middle-aged or older adults should pay especially close attention to these habits
It is also important to regularly check liver and gallbladder health. Most gallstones cause no obvious symptoms and are therefore difficult to notice. In fact, asymptomatic gallstones are more often found incidentally during abdominal ultrasound examinations as part of health checkups. Park explained, “Not all gallstones require treatment, but confirming and managing their location, size and whether symptoms are present can help assess the risk of complications such as cholecystitis, cholangitis and pancreatitis.”
◇Sudden upper abdominal biliary colic is the hallmark symptom, often mistaken for gastritis or indigestion
When gallstones block the flow of bile in the gallbladder or bile ducts, they can cause abdominal pain, nausea and other symptoms. The most characteristic symptom is biliary colic, which usually occurs in the upper abdomen or right upper abdomen. It is caused by increased pressure inside the gallbladder as a stone blocks the cystic duct, and it is often mistaken for indigestion, gastritis or a stomach upset
Biliary colic caused by gallstones brings on sudden pain. Unlike gastritis or indigestion, which cause persistent heartburn, this pain appears abruptly and can last from 30 minutes to several hours. Nausea and vomiting may also occur along with abdominal pain. If such pain repeatedly follows overeating or a greasy, high-fat meal, it may be biliary colic. If the pain lasts more than five to six hours or is accompanied by fever, there is a risk of complications such as acute cholecystitis, so it is important to seek medical attention as soon as possible.
Abdominal ultrasound is the most basic test for diagnosing gallstones and can detect stones in more than 90% of cases. If needed, CT scans and magnetic resonance cholangiopancreatography (MRCP) are also used to examine the bile ducts and pancreatic ducts. Based on the location and size of the stones, as well as whether inflammation has developed, doctors decide on the appropriate treatment
Even if gallstones are present, patients are often simply monitored without treatment if they have no symptoms and no risk of gallbladder cancer or complications. On the other hand, if the stones are causing pain, or if the patient has no symptoms but faces a high risk of complications, surgery may be recommended based on a specialist’s judgment. In particular, stones larger than 3 cm, porcelain gallbladder, gallbladder polyps or Pancreaticobiliary maljunction may be considered for preventive removal even when there are no symptoms.
The most common surgical treatment is Cholecystectomy. Today, laparoscopic Cholecystectomy is mainly performed. It involves a smaller incision and, depending on the patient, recovery can be fast enough for discharge within one or two days. However, depending on the condition and location of the stones, the liver and pancreas may also need to be examined and additional treatment may be required. If gallstones are suspected, it is best to visit a hospital with a hepatobiliary and pancreatic specialist.
In a very small number of patients with pure cholesterol stones that are smaller than 1.5 cm and whose gallbladder function is preserved, treatment with ursodeoxycholic acid (UDCA) may be used to reduce the amount of cholesterol in bile and dissolve the stones. However, because the recurrence risk can be as high as 50% after stopping the medication, treatment plans should be made in consultation with a specialist
Park said, “Gallstones are a condition that requires continuous follow-up and management, as even asymptomatic patients are known to develop pain and other symptoms in about 1% to 2% of cases each year.” He added, “People should avoid lifestyle habits that increase the risk of gallstones, and if sudden abdominal pain or digestive symptoms keep recurring, I recommend getting an accurate diagnosis from a specialist.”
Jang Jong-ho, bellho@sportschosun.com
