Sudden upper abdominal pain in your 40s–50s — suspect ‘cholecystitis’

 Gallstones cause inflammation… acute and chronic symptoms differ greatly
Director Park Kwan-tae of St. Peter's Hospital: “You need a specialist who looks at the gallbladder, pancreas and bile ducts as a whole”
[Uihaksinmun·Ilgan Bosa] The gallbladder, commonly known in Korean as 'sseulgae', is a major digestive organ located in the upper abdomen; though not large, it has an important influence on the digestive process. However, because the gallbladder faces a rising risk of inflammation and gallstones alongside declining metabolism with age, care is needed.

In practice, cholecystitis cases begin to rise in earnest from the 40s and 50s. According to Health Insurance Review and Assessment Service data, among cholecystitis (K81) patients in 2024 those in their 40s outnumbered those in their 30s by about 1.4 times. Among people in their 60s, patient numbers were double those in their 30s, the largest of any age group.

Inflammation of the gallbladder goes beyond simple pain and has a high likelihood of causing complications through tissue changes and reduced function. In particular, from the 40s onward, metabolic factors and unhealthy lifestyle habits tend to worsen, so it is important to look after gallbladder health.

The gallbladder sits near the liver, stores bile and sends it through the bile duct to the duodenum, playing an important role in digestion. For that reason, the liver, gallbladder, bile ducts and pancreas are often assessed together in clinical practice. When the bile duct becomes blocked or abnormal and bacteria invade the bile, cholecystitis develops.

Gallstones in particular are the most common cause of inflammation in the gallbladder. A gallstone is a kind of stone that forms when the components of bile secreted by the liver become imbalanced and harden. When a gallstone blocks the cystic duct, pressure inside the gallbladder rises and causes distension, and inflammation often develops secondarily.

The great majority of acute cholecystitis in particular is known to be caused by gallstones. In chronic cholecystitis as well, gallstones continuously irritate the gallbladder and cause histological changes in the organ, leading to inflammation.

Obesity, diabetes, lipid abnormalities and other conditions involving fat deposition, raised cholesterol, and metabolic disease are the main factors that increase the risk of these gallstones. Accordingly, when eating habits such as overeating and a high-calorie diet continue, gallstone formation and inflammation can easily impair the function of each organ.

If poor eating habits continue after middle age, there is a high risk of placing a cumulative and excessive burden on the gallbladder. Conversely, sudden weight loss also affects gallstone formation. In fact, there are reports that gallstones develop in about 25% of people who have gone on an extreme diet.

Cholecystitis is characterized by markedly different symptoms in its acute and chronic forms. Many patients with acute cholecystitis present with severe right upper abdominal pain, nausea, vomiting and fever. On palpation, pressing the right upper abdomen may provoke intense pain. Chronic cholecystitis, by contrast, is often asymptomatic; when symptoms do appear, they center on the upper abdomen as bloating, discomfort and a feeling of fullness, and are easily mistaken for a stomach problem.

Choosing a hospital with a hepatobiliary-pancreatic specialist helps treatment

Cholecystitis is diagnosed mainly by abdominal ultrasound. About 90-95% of gallstones can be visualized on ultrasound. In patients with cholecystitis, ultrasound can show gallstones inside the gallbladder and a thickened gallbladder wall caused by inflammation or fibrosis.

In patients with acute cholecystitis, blood tests may show a rising white blood cell count, or fluid may be found collected around the gallbladder. Additional tests are also carried out as needed before a diagnosis is made.

Treatment varies with the patient’s condition. For acute cholecystitis, surgical removal of the organ is the standard treatment. The gallbladder stores and concentrates bile, and normal digestive function is maintained even after it is removed. When symptoms are mild, oral dissolution therapy using medication to dissolve the stones may be used, but it has the drawback that complete dissolution occurs in under 30% of cases and about half of patients relapse after five years or more.

For chronic cholecystitis, the principle is that no specific treatment is given if there are no symptoms. However, since there is a long-term risk of progression to acute cholecystitis, once gallstones are found it is advisable to track changes with periodic abdominal ultrasound. If symptoms resembling acute cholecystitis, such as sudden abdominal pain, appear later, it is best to visit a hospital promptly for care.

In particular, if cholecystitis is suspected, it is best to visit a hospital with a hepatobiliary-pancreatic specialist who can assess the gallbladder, pancreas and bile ducts together. Complications can arise in 10% of acute cholecystitis patients, and even chronic cases sometimes progress to acute disease depending on how the condition develops, so it is important to receive long-term care that covers both medical and surgical perspectives.

If you feel pain in the upper abdomen that you have not felt before, you should not ignore it even if the symptom disappears for a time. Above all, it is important to obtain an early diagnosis from a specialist who can examine the gallbladder, pancreas and bile ducts comprehensively.