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

 Poor eating habits form gallstones and cause inflammation

The gallbladder is a major digestive organ located in the upper abdomen and plays an important role in digestion. The problem is that as we age, metabolism slows and the risk of inflammation and gallstones tends to rise.

In practice, cholecystitis cases begin to rise in earnest from the 40s. According to Health Insurance Review and Assessment Service data, among cholecystitis 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 main cause is gallstones. Gallstones are concretions formed by an imbalance in the components of bile secreted by the liver. When a stone blocks the cystic duct, pressure inside the gallbladder rises and causes it to distend, with inflammation developing secondarily.  

Fat deposition, raised cholesterol and metabolic disease are known to increase the risk of gallstones. Easily overlooked, sudden weight loss also affects stone formation. Park Kwan-tae, Director of General Surgery at St. Peter's Hospital, explained, "There are reports that gallstones develop in about 25% of people who have gone on severe diets."

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.

Cholecystitis is diagnosed mainly with abdominal ultrasound. In cholecystitis, ultrasound shows stones within the gallbladder and a gallbladder wall thickened by inflammation or fibrosis. In acute cholecystitis, blood tests may show a rising white blood cell count, and fluid may collect around the gallbladder.  

The measures taken differ according to the patient's condition. For patients with acute cholecystitis, surgical treatment to remove the organ is performed as standard. The gallbladder is an organ that stores and concentrates bile, and normal digestive function is maintained even after it is removed. If symptoms are mild, oral dissolution therapy using medication to dissolve the gallstones 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.

Director Park Kwan-tae stressed, “If you feel pain in the upper abdomen that you have not felt before, do not ignore it even if the symptom goes away for a while.” He added, “What matters most is getting an early diagnosis from a specialist who can assess the gallbladder, pancreas and bile ducts together.”  

Source: Health Joongang (https://jhealthmedia.joins.com)