Gallstones: Causes, Symptoms & Treatment

Gallstones are hardened deposits, ranging from tiny grains to golf-ball sized stones, that form inside the gallbladder from an imbalance in bile composition. They're common, and the large majority never cause a problem at all — the real clinical question isn't simply whether stones are present, but whether they're causing symptoms or complications that need treatment. At KAGE, that distinction — symptomatic versus silent — is what actually determines the management plan, rather than treating every gallstone finding the same way.

Gallstone prevalence in India is estimated at around 4%, notably lower than the roughly 10% reported in Western countries, though Indian studies show considerable regional variation, with some reporting figures as low as 2% and others considerably higher. Certain areas of the Gangetic basin in North India — including parts of Bihar and Uttar Pradesh — have been informally described as a 'stone belt,' with prevalence attributed in part to water quality factors specific to that region. In South India, a study identified a distinctly local dietary risk profile: higher body mass index, increased tamarind consumption, greater fried food intake, and oil intake above 300ml per week were all significantly associated with gallstone risk — relevant, practical information for a population where these are common dietary patterns, not generic advice imported from elsewhere.

This distinction is more than academic — it reflects genuinely different underlying processes, though the approach to symptomatic disease is generally similar regardless of stone type.

• Many gallstones cause no symptoms at all ('silent' gallstones) and are found incidentally
• Biliary colic — sudden, intense pain in the upper right abdomen or center of the abdomen, often after a fatty meal, that can last from minutes to a few hours
• Pain that may radiate to the right shoulder or back
• Nausea or vomiting during an episode
• Bloating or discomfort after eating fatty foods

• Female sex — gallstones are roughly twice as common in women in Indian data
• Age, with peak incidence in the 40s and 50s
• Obesity and high BMI
• Family history — found in a majority of gallstone patients in one Indian study
• Diabetes
• Hypothyroidism — an often-overlooked risk factor; screening for thyroid dysfunction is worthwhile in gallstone patients who also have abnormal cholesterol levels
• Pregnancy and hormonal factors, including oral contraceptive or hormone replacement therapy use
• In South Indian patients specifically: diets higher in tamarind, fried food, and oil

• Abdominal ultrasound — the standard, highly reliable first test for detecting gallstones
• Blood tests — to check for signs of infection, inflammation, or bile duct obstruction if complications are suspected
• MRCP or ERCP — used specifically when a stone is suspected to have moved into the bile duct rather than remaining in the gallbladder

• Silent (asymptomatic) gallstones: generally no treatment needed — watchful waiting is appropriate for most patients, since only a small proportion ever become symptomatic
• Symptomatic gallstones: laparoscopic cholecystectomy (surgical removal of the gallbladder) is the standard, definitive treatment
• Stones that have migrated into the bile duct (choledocholithiasis): managed endoscopically via ERCP, often before or alongside gallbladder removal
• Dietary modification can reduce symptom frequency in some patients but doesn't dissolve existing stones or replace definitive treatment for symptomatic disease

If gallstones are found without symptoms, ongoing treatment usually isn't necessary — but it's still worth understanding your own risk. Roughly 3% of people with silent gallstones develop symptoms each year, so being aware of the classic symptoms (particularly pain after fatty meals) means you'll recognize if and when the situation changes, rather than being caught off guard. There's no proven diet that reliably dissolves existing gallstones, though maintaining a healthy weight and moderate fat intake is reasonable general practice regardless.

• Acute cholecystitis — inflammation or infection of the gallbladder, usually from a stone blocking its outlet
• Choledocholithiasis — a stone migrating into and blocking the bile duct (see the dedicated Bile Duct Stones page)
• Cholangitis — a serious bile duct infection, a medical emergency
• Gallstone pancreatitis — inflammation of the pancreas triggered by a stone obstructing the shared duct
• Gallbladder cancer — rare, but long-standing gallstone disease is a recognized risk factor, and regions with higher gallstone prevalence in India have also shown higher gallbladder cancer rates

Gallstones need treatment when they cause symptoms or migrate out of the gallbladder. Bile duct stones are cleared endoscopically by ERCP, and where the duct cannot be reached that way our gastroenterologists use EUS-guided biliary drainage — advanced endoscopy that avoids open surgery. Rapid weight loss is a known link between obesity and gallstones, and stones presenting in pregnancy are managed through the Women's GI Clinic. To have an ultrasound report reviewed, book a consultation.