Gallstones: Symptoms, Diagnosis and When Surgery May Be Needed

Gallstones are one of the most common digestive conditions worldwide, yet many people who have them never experience a single symptom. For others, a gallstone can cause sudden, severe abdominal pain that demands immediate medical attention.

At Dr. Lodaya Hospital in Haveri, our gastroenterology and surgical teams work together to diagnose gallstone disease accurately and determine when surgery is genuinely necessary—and when it is not.

This evidence-based guide explains what gallstones are, how they present, how they are diagnosed, and the situations in which surgery is recommended.

What Are Gallstones?

Gallstones (cholelithiasis) are hard, pebble-like deposits that form in the gallbladder, a small organ beneath the liver that stores bile. Most stones are made primarily of cholesterol, while others are pigment stones composed of bilirubin. [1]

In developed countries, more than 90% of gallstones are cholesterol stones. [2] Many people carry gallstones for years without knowing it—a condition called asymptomatic cholelithiasis. These stones are often discovered incidentally during an ultrasound performed for another reason. [2]

In India, the prevalence of gallstone disease varies widely by region, with population-based studies reporting rates between approximately 3% and 9%, and some community studies reporting higher figures. [3] Women are two to three times more likely to develop gallstones than men. [4]

Symptoms of Gallstones

Biliary Colic: The Most Common Symptom

The hallmark symptom is biliary colic—a severe, constant pain in the upper right abdomen or upper middle of the abdomen that lasts longer than 30 minutes. [2] The pain may:

* Begin after a fatty meal or at night
* Radiate to the right shoulder or back
* Be accompanied by nausea and vomiting

Biliary colic occurs when a stone temporarily blocks the cystic duct, causing the gallbladder to contract against an obstruction. [2] Once the stone falls back, the pain resolves—but it can recur.

Important: Gallstones do not cause vague indigestion, bloating, or fat intolerance. These symptoms are often incorrectly attributed to gallstones but are usually due to other causes. [2]

When Complications Develop

Most people with gallstones remain asymptomatic, but complications develop in approximately 3% of symptomatic patients each year. [2] These include:

Complication	Typical Features
Acute cholecystitis	Persistent right upper abdominal pain, fever, nausea, positive Murphy's sign [2]
Choledocholithiasis	Jaundice, dark urine, pale stools, pain [1]
Cholangitis	Fever, jaundice, and right upper abdominal pain (Charcot's triad) [2]
Gallstone pancreatitis	Severe epigastric pain radiating to the back, vomiting [2]

These are medical emergencies requiring urgent evaluation. [1,2]

Risk Factors

Common risk factors for gallstones include: [2,3]

* Female sex and pregnancy
* Increasing age
* Obesity and metabolic syndrome
* Rapid weight loss or prolonged fasting
* Family history of gallstones
* Certain medications (for example, ceftriaxone and some GLP-1 receptor agonists)
* Physical inactivity
* In the Indian context, higher body mass index and diets high in fried foods and excess oil have been associated with gallstone disease [3]

How Are Gallstones Diagnosed?

First-Line Investigations

Abdominal ultrasound is the most effective and widely used imaging test for gallstones. It is non-invasive, readily available, and can detect stones, gallbladder wall thickening, and signs of inflammation. [2]

Blood tests are also performed to assess for complications: [2]

* Complete blood count — to look for infection or inflammation
* Liver function tests — to detect bile duct obstruction
* Serum lipase and amylase — to evaluate for pancreatitis

Further Imaging When Needed

If a stone in the bile duct is suspected (for example, because of jaundice or a dilated duct on ultrasound), further evaluation may include:

* MRCP (magnetic resonance cholangiopancreatography) — a non-invasive MRI-based technique to visualise the bile ducts [2]
* ERCP (endoscopic retrograde cholangiopancreatography) — used both to confirm and to remove stones from the bile duct [2]
* CT scan — in selected cases or when complications are suspected [2]

When Is Surgery Needed?

Surgery is not recommended for every person with gallstones. The decision depends on whether stones are causing symptoms or complications.

Surgery Is Generally Recommended for:

1. Symptomatic gallstones
Patients with biliary colic or other symptoms attributable to gallstones should be offered laparoscopic cholecystectomy—surgical removal of the gallbladder. This is the definitive treatment and prevents recurrent pain and complications. [2,5]
2. Acute cholecystitis
For patients with acute cholecystitis, early laparoscopic cholecystectomy is recommended, ideally within 7–10 days of symptom onset. [5] Early surgery is associated with high success rates and reduces the risk of recurrent biliary events. [5]
3. Gallstone pancreatitis
Patients who have had gallstone pancreatitis should undergo cholecystectomy after recovery to prevent recurrence. In suitable patients, this may be performed during the same hospital admission. [2]
4. Cholangitis or bile duct stones
When stones are present in the bile duct, they are usually removed endoscopically (ERCP) first, followed by cholecystectomy to prevent further stone migration. [2]

Surgery Is Usually Not Needed for:

Asymptomatic gallstones
People with gallstones discovered incidentally and who have no symptoms generally do not require surgery. The risks of surgery are not justified when the stones are not causing harm. [2,5]

What About Non-Surgical Treatment?

Oral bile acid therapy (ursodeoxycholic acid) can dissolve small cholesterol stones in selected patients who cannot undergo surgery, but it takes months to years, stones frequently recur after treatment is stopped, and it is rarely used in modern practice. [1,2]

What to Expect After Gallbladder Removal

The gallbladder is not essential for digestion. After removal, bile flows directly from the liver into the small intestine. Most patients tolerate the procedure well and resume normal activities within a few weeks. A small proportion may experience looser stools or mild digestive changes initially, which usually settle over time.

Preventing Gallstones

While not all gallstones can be prevented, the following measures may reduce risk: [1,3]

* Maintain a healthy body weight
* Avoid rapid weight loss and prolonged fasting
* Eat a fibre-rich diet with plenty of vegetables and whole grains
* Limit fried foods and excess oil
* Stay physically active

When to See a Doctor

Seek medical attention promptly if you experience:

* Severe or persistent pain in the upper right abdomen [2]
* Pain accompanied by fever or chills [2]
* Yellowing of the eyes or skin (jaundice) [1]
* Persistent nausea and vomiting [2]
* Pain radiating to the back or right shoulder [2]

If you have known gallstones and develop any of these symptoms, urgent evaluation is needed to rule out complications. [1,2]

Take the First Step

Gallstones are common, and most people with them will never need surgery. But when symptoms or complications occur, timely and appropriate treatment matters.

We invite you to schedule a consultation with our gastroenterology and surgical team at Dr. Lodaya Hospital, Haveri. We will review your symptoms, arrange appropriate imaging and blood tests, and explain clearly whether surgery is recommended in your case—and why.

Contact Dr. Lodaya Hospital in Haveri to book your appointment.

References

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gallstones. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones
2. BMJ Best Practice. Cholelithiasis. Last updated August 2025.
3. Premkumar K, Kini PR, Murali R, et al. Indian Literature Review on Gallstones. Gastroenterology, Hepatology and Endoscopy Practice. 2025;5(3):103-106.
4. Mehta’s Hospitals. Editors Note, October 2025. Citing ICMR and Indian Journal of Gastroenterology data.
5. European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. Journal of Hepatology. 2016;65(1):146-181.

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