Abdominal pain after a crash diet? Suspect 'gallstones'…patients in their 20s to 50s rise in summer
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St. Peter's Hospital 26-08-17 10:04Main content
[Sports Chosun, reporter Jang Jong-ho] Severe abdominal pain and indigestion that follow short-term summer dieting or a sudden high-fat meal should not simply be shrugged off as an upset stomach.
It may be that 'gallstone disease' has developed.
Gallstone disease is a condition in which older adults make up a high proportion of cases, to the extent that more than half of all patients are in their 60s or older. Recently, however, the overall number of patients has been steadily increasing. According to Health Insurance Review and Assessment Service data, the number of patients treated for gallstone disease in Korea rose from 192,551 in 2018 to more than 200,000 for the first time in 2019, reaching about 286,700 in 2025. That amounts to an increase of about 49% in patients over seven years.
In particular, the number of 'young gallstone' patients has been rising in summer. Looking at the average monthly increase in patients in July and August compared with June over the past three years, the figure rose 8.4% among people in their 20s and 30s and 9.4% among those in their 40s and 50s. That is 1.5 and 1.7 times the 5.6% average increase among patients aged 60 and over during the same period.
Experts point to summer lifestyle habits as one of the reasons behind this rise in gallstone cases among people in their 20s to 50s during the summer.
Park Kwan-tae, general surgery specialist and Director of the Hepatobiliary-Pancreatic & Vascular Center at St. Peter's Hospital, explained, “Gallstone disease is influenced by a range of factors, including obesity, eating habits and rapid weight loss.” He added, “In summer in particular, short-term dieting, irregular meals and extreme dietary restriction all increase, so the risk of gallstone disease rises among younger people.”
◇Excessive summer weight loss and extreme diets raise the risk of gallstones
Gallstone disease is a condition in which sediment in the bile settles and hardens into stones in the gallbladder and bile ducts. The liver produces about 750mL of bile a day, and bile is made up of cholesterol, fats, bile salts, protein and bilirubin. When the balance among these components shifts, sediment forms in the gallbladder and gallstones develop.
Among them, the cholesterol gallstone, caused by excess cholesterol in the bile, is the most common type. Cholesterol stones are also closely linked to obesity and a diet based on meat and high-fat food, so care is needed among younger age groups as well. In addition, estrogen, the female hormone, acts to raise cholesterol levels in the bile, so women should be especially careful.
Dr. Park, Kwan Tae points out, "Rapid weight loss over a short period and restricted eating in particular lower gallbladder function and readily bring on gallstones." Rapid weight loss with GLP-1 drugs, whose use has been growing recently, is also analysed as being linked to a higher risk of gallbladder disease such as gallstones. Extreme fasting and very-low-fat, very-low-calorie diets likewise reduce gallbladder contraction, creating conditions in which bile easily stagnates.
The best way to prevent gallstones from forming is to exercise regularly and maintain healthy eating habits. In particular, long spells of fasting and extreme dietary restriction for the purpose of summer dieting are best avoided as far as possible, and weight loss too is better carried out slowly, over time. People with a family history of gallstone disease, those who are obese and middle-aged and older adults in particular need to pay especially close attention to these habits.
Checking liver and gallbladder health regularly is also important, because most gallstones cause no particular symptoms and are therefore hard to notice. In fact, asymptomatic gallstones are more often found incidentally on abdominal ultrasound during a health screening. Director Park Kwan-tae explained, "Not every gallstone needs treatment, but checking and managing the location and size of the stones and whether there are symptoms in advance helps to gauge the risk of complications such as cholecystitis, cholangitis and pancreatitis."
◇Sudden ‘biliary colic’ in the upper abdomen is the hallmark symptom… often mistaken for gastritis or indigestion
When gallstones block the flow of bile in the gallbladder or bile ducts, they cause various symptoms such as abdominal pain and nausea. The most characteristic is biliary colic, which occurs mainly in the upper abdomen and the right upper abdomen. The pain arises as a stone blocks the cystic duct and pressure inside the gallbladder rises, and it is not uncommon for it to be mistaken for indigestion, gastritis or dyspepsia.
Biliary colic caused by gallstone disease brings on sudden pain. Unlike gastritis or indigestion, in which heartburn persists, severe pain begins suddenly and lasts from as little as 30 minutes to as long as several hours. Nausea and vomiting may accompany the abdominal pain, and if such pain recurs after overeating or a greasy, high-fat meal in particular, biliary colic is a possibility. If the pain lasts more than five or six hours or is accompanied by fever, there is a risk of complications such as acute cholecystitis, so it is important to get to a hospital as quickly as possible.
Abdominal ultrasound is the most basic examination for diagnosing gallstone disease and can detect gallstones in more than 90% of cases. If necessary, the bile and pancreatic ducts are also examined with CT or magnetic resonance cholangiopancreatography (MRCP). This confirms the location and size of the stones and whether they have caused inflammation, after which the direction of treatment is decided according to the symptoms.
Even when gallstones are present, if there are no symptoms and no risk of gallbladder cancer or complications, the patient is in many cases simply monitored without separate treatment. If the stones cause pain, or if the risk of complications is high even without symptoms, surgical treatment is performed at the specialist’s discretion. In particular, when the stones are 3cm or larger, or are accompanied by a porcelain (calcified) gallbladder, gallbladder polyps or pancreaticobiliary maljunction, preventive removal is considered even for asymptomatic stones.
The most representative form of surgical treatment is cholecystectomy. Laparoscopic cholecystectomy is now mainly performed; the incision is small and recovery is fast enough that, depending on the patient, discharge is possible after 1–2 days. Depending on the condition and location of the stones, however, the liver and pancreas as well as the gallbladder may need to be examined and further treatment may be required, so if gallstone disease is suspected it is advisable to visit a hospital with a hepatobiliary-pancreatic specialist wherever possible.
In a very small number of patients — those with pure cholesterol stones smaller than 1.5cm and preserved gallbladder function — treatment with UDCA (ursodeoxycholic acid) may be given to reduce the amount of cholesterol in the bile and dissolve the stones. In these cases, however, the risk of recurrence can reach 50% if the medication is stopped, so the treatment plan should be drawn up in consultation with a specialist.
Director Park Kwan-tae urged, “Gallstone disease requires continued follow-up and management, since about 1–2% of even asymptomatic patients are known to develop pain or other symptoms each year.” He added, “Avoid lifestyle habits that raise the risk of gallstones, and if sudden abdominal pain or digestive symptoms keep recurring, we recommend getting an accurate diagnosis from a specialist.”
It may be that 'gallstone disease' has developed.
Gallstone disease is a condition in which older adults make up a high proportion of cases, to the extent that more than half of all patients are in their 60s or older. Recently, however, the overall number of patients has been steadily increasing. According to Health Insurance Review and Assessment Service data, the number of patients treated for gallstone disease in Korea rose from 192,551 in 2018 to more than 200,000 for the first time in 2019, reaching about 286,700 in 2025. That amounts to an increase of about 49% in patients over seven years.
In particular, the number of 'young gallstone' patients has been rising in summer. Looking at the average monthly increase in patients in July and August compared with June over the past three years, the figure rose 8.4% among people in their 20s and 30s and 9.4% among those in their 40s and 50s. That is 1.5 and 1.7 times the 5.6% average increase among patients aged 60 and over during the same period.
Experts point to summer lifestyle habits as one of the reasons behind this rise in gallstone cases among people in their 20s to 50s during the summer.
Park Kwan-tae, general surgery specialist and Director of the Hepatobiliary-Pancreatic & Vascular Center at St. Peter's Hospital, explained, “Gallstone disease is influenced by a range of factors, including obesity, eating habits and rapid weight loss.” He added, “In summer in particular, short-term dieting, irregular meals and extreme dietary restriction all increase, so the risk of gallstone disease rises among younger people.”
◇Excessive summer weight loss and extreme diets raise the risk of gallstones
Gallstone disease is a condition in which sediment in the bile settles and hardens into stones in the gallbladder and bile ducts. The liver produces about 750mL of bile a day, and bile is made up of cholesterol, fats, bile salts, protein and bilirubin. When the balance among these components shifts, sediment forms in the gallbladder and gallstones develop.
Among them, the cholesterol gallstone, caused by excess cholesterol in the bile, is the most common type. Cholesterol stones are also closely linked to obesity and a diet based on meat and high-fat food, so care is needed among younger age groups as well. In addition, estrogen, the female hormone, acts to raise cholesterol levels in the bile, so women should be especially careful.
Dr. Park, Kwan Tae points out, "Rapid weight loss over a short period and restricted eating in particular lower gallbladder function and readily bring on gallstones." Rapid weight loss with GLP-1 drugs, whose use has been growing recently, is also analysed as being linked to a higher risk of gallbladder disease such as gallstones. Extreme fasting and very-low-fat, very-low-calorie diets likewise reduce gallbladder contraction, creating conditions in which bile easily stagnates.
The best way to prevent gallstones from forming is to exercise regularly and maintain healthy eating habits. In particular, long spells of fasting and extreme dietary restriction for the purpose of summer dieting are best avoided as far as possible, and weight loss too is better carried out slowly, over time. People with a family history of gallstone disease, those who are obese and middle-aged and older adults in particular need to pay especially close attention to these habits.
Checking liver and gallbladder health regularly is also important, because most gallstones cause no particular symptoms and are therefore hard to notice. In fact, asymptomatic gallstones are more often found incidentally on abdominal ultrasound during a health screening. Director Park Kwan-tae explained, "Not every gallstone needs treatment, but checking and managing the location and size of the stones and whether there are symptoms in advance helps to gauge the risk of complications such as cholecystitis, cholangitis and pancreatitis."
◇Sudden ‘biliary colic’ in the upper abdomen is the hallmark symptom… often mistaken for gastritis or indigestion
When gallstones block the flow of bile in the gallbladder or bile ducts, they cause various symptoms such as abdominal pain and nausea. The most characteristic is biliary colic, which occurs mainly in the upper abdomen and the right upper abdomen. The pain arises as a stone blocks the cystic duct and pressure inside the gallbladder rises, and it is not uncommon for it to be mistaken for indigestion, gastritis or dyspepsia.
Biliary colic caused by gallstone disease brings on sudden pain. Unlike gastritis or indigestion, in which heartburn persists, severe pain begins suddenly and lasts from as little as 30 minutes to as long as several hours. Nausea and vomiting may accompany the abdominal pain, and if such pain recurs after overeating or a greasy, high-fat meal in particular, biliary colic is a possibility. If the pain lasts more than five or six hours or is accompanied by fever, there is a risk of complications such as acute cholecystitis, so it is important to get to a hospital as quickly as possible.
Abdominal ultrasound is the most basic examination for diagnosing gallstone disease and can detect gallstones in more than 90% of cases. If necessary, the bile and pancreatic ducts are also examined with CT or magnetic resonance cholangiopancreatography (MRCP). This confirms the location and size of the stones and whether they have caused inflammation, after which the direction of treatment is decided according to the symptoms.
Even when gallstones are present, if there are no symptoms and no risk of gallbladder cancer or complications, the patient is in many cases simply monitored without separate treatment. If the stones cause pain, or if the risk of complications is high even without symptoms, surgical treatment is performed at the specialist’s discretion. In particular, when the stones are 3cm or larger, or are accompanied by a porcelain (calcified) gallbladder, gallbladder polyps or pancreaticobiliary maljunction, preventive removal is considered even for asymptomatic stones.
The most representative form of surgical treatment is cholecystectomy. Laparoscopic cholecystectomy is now mainly performed; the incision is small and recovery is fast enough that, depending on the patient, discharge is possible after 1–2 days. Depending on the condition and location of the stones, however, the liver and pancreas as well as the gallbladder may need to be examined and further treatment may be required, so if gallstone disease is suspected it is advisable to visit a hospital with a hepatobiliary-pancreatic specialist wherever possible.
In a very small number of patients — those with pure cholesterol stones smaller than 1.5cm and preserved gallbladder function — treatment with UDCA (ursodeoxycholic acid) may be given to reduce the amount of cholesterol in the bile and dissolve the stones. In these cases, however, the risk of recurrence can reach 50% if the medication is stopped, so the treatment plan should be drawn up in consultation with a specialist.
Director Park Kwan-tae urged, “Gallstone disease requires continued follow-up and management, since about 1–2% of even asymptomatic patients are known to develop pain or other symptoms each year.” He added, “Avoid lifestyle habits that raise the risk of gallstones, and if sudden abdominal pain or digestive symptoms keep recurring, we recommend getting an accurate diagnosis from a specialist.”