Upper abdominal pain in your 40s–50s? Suspect cholecystitis — early diagnosis is key

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

Seeing a hepatobiliary-pancreatic specialist favors long-term treatment

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- Cholecystitis cases rise sharply from the 40s and 50s and peak after 60↑ gallbladder checks become more important with age

- Poor eating habits harden bile into gallstones that cause inflammation… acute and chronic symptoms differ greatly

- Diagnosis and treatment differ by symptom… choose a hospital where General Surgery and Gastroenterology can work together

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▲Upper abdominal pain caused by cholecystitis

The gallbladder, a major digestive organ located in the upper abdomen, is small but has an important effect on digestion. With age, however, the gallbladder faces a growing risk of inflammation and gallstones alongside declining metabolism, so caution 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.

Park Kwan-tae, Director of General Surgery at St. Peter's Hospital, explains, “Inflammation of the gallbladder goes beyond simple pain — tissue changes and reduced function make complications quite likely.” He adds, “Especially after age 40, metabolic factors and unhealthy lifestyle habits tend to worsen, so it is important to keep an eye on gallbladder health.”

■ Overeating and drinking form gallstones that block the bile duct and cause inflammation... see a doctor without delay if upper abdominal pain appears

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 are the most common cause of inflammation in the gallbladder. A gallstone is a hardened concretion formed by an imbalance in the components of the bile secreted by the liver. When a stone blocks the cystic duct, pressure inside the gallbladder rises and causes distension, which frequently leads to secondary inflammation. The great majority of acute cholecystitis in particular is known to be caused by gallstones. In chronic cholecystitis as well, stones continuously irritate the gallbladder and cause histological changes in the organ, producing inflammation.

Obesity, diabetes and lipid disorders — along with fat deposition, elevated cholesterol and metabolic disease — are major factors that raise the risk of gallstones. When eating habits such as overeating and high-calorie diets persist, stone formation and inflammation readily impair the function of the organs involved. Continuing poor eating habits after middle age in particular carries a high risk of placing a cumulative burden on the gallbladder. Conversely, sudden weight loss also affects gallstone formation; some reports indicate that gallstones develop in about 25% of people who follow 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.

▲Dr. Park, Kwan Tae, General Surgery, St. Peter's Hospital

■ Choosing a hospital with a hepatobiliary-pancreatic specialist helps, in case of complications or a shift between chronic and acute disease

Cholecystitis is diagnosed mainly with abdominal ultrasound. Ultrasound can detect roughly 90-95% of gallstones. In patients with cholecystitis, ultrasound may show stones within the gallbladder and a gallbladder wall thickened by inflammation or fibrosis. In acute cholecystitis in particular, blood tests may show an elevated white blood cell count, and fluid may be found collected around the gallbladder. Additional tests are also performed as needed to reach a diagnosis.

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.

Park Kwan-tae, general surgery specialist and Director at St. Peter's Hospital, 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.”