Earliest Gallstones Signs: 5 Ways to Recognize Them by Typical Symptoms

Gallstones are one of the common digestive diseases in Vietnam. According to many medical statistics, about 10–15% of adults may have gallstones, but most are unaware because the symptoms are subtle. Only when severe pain occurs in the right hypochondriac region or complications such as cholecystitis arise do many people discover the condition.

If you are wondering whether abdominal pain, bloating, or indigestion could be signs of gallstones, this article will help you understand the common gallstone symptoms, cases without typical manifestations, and the precise diagnostic methods used by doctors. Tiptory will help you recognize the risk early to proactively seek timely examination, treatment, and limit dangerous complications caused by gallstones.

Part 1: Typical signs of gallstones

Method 1: Gallstones may not cause symptoms

Many cases of gallstones have no clear symptoms

• Gallstones often develop silently and can remain in the gallbladder for many years without significantly affecting health.

• According to medical studies, most people with gallstones do not experience signs of gallstones or gallstone symptoms for a long time.

• Only about 5–10% of people with gallstones will experience symptoms such as right hypochondriac pain, bloating, nausea, or indigestion after eating fatty foods.

No symptoms does not mean no disease

• In fact, fewer than half of people with gallstones ever experience any symptoms of the disease.

• Therefore, you should not rely solely on subjective feelings to determine whether you have gallstones.

• Many cases are only incidentally discovered during an abdominal ultrasound during routine health check-ups or when examining another issue.

Medical examination is the most accurate diagnostic method

• If you suspect signs of gallstones or belong to a high-risk group such as being overweight, over 40 years old, having a family history of the disease, or frequently experiencing abdominal pain after eating, you should visit a medical facility for examination.

• The doctor will evaluate symptoms, conduct a clinical examination, and order necessary tests or ultrasounds to determine whether gallstones are present.

• Early detection helps monitor and treat at the right time, reducing the risk of complications such as cholecystitis, bile duct obstruction, or acute pancreatitis.

Method 2: Recognizing gallstone colic pain

Pay attention to the characteristic pains of gallstones

• One of the typical gallstone symptoms is biliary colic. The pain usually occurs in the right hypochondriac region or the epigastric region (just below the sternum).

• Patients may feel a dull ache that gradually intensifies into severe pain, accompanied by nausea or vomiting.

• The pain often lasts over 15 minutes, even several hours, and may radiate to the back or right shoulder.

Pain often recurs in episodes

• After the first occurrence, biliary colic tends to recur many times, especially after fatty meals or at night.

• The pain may resolve on its own and then return after a few weeks, months, or just a few times a year.

• The time between pain episodes makes many people complacent, delaying the detection of gallstones.

Easily confused with other digestive diseases

• Signs of gallstones can resemble stomach pain, indigestion, GERD, or pain due to gastrointestinal spasms.

• If based solely on symptoms, it is very difficult to accurately determine the cause of abdominal pain.

• Therefore, when recurrent pain appears in the right hypochondriac region or epigastrium, especially after eating, you should not self-diagnose at home.

Seek medical attention if suspected biliary colic

• If you suspect you have gallstone symptoms or frequently experience biliary colic, seek medical attention as soon as possible.

• The doctor may order an abdominal ultrasound or necessary tests to identify gallstones and assess the risk of complications.

• Early diagnosis helps select appropriate treatment methods, reducing the risk of cholecystitis, bile duct obstruction, or acute pancreatitis caused by stones.

Method 3: Monitoring symptoms after eating high-fat foods

Observe your body after high-fat meals

• If you suspect you have gallstones, pay attention to how your body feels after eating high-fat meals or overeating.

• Foods like fried meat, fast food, organ meats, sausages, bacon, or other fatty dishes can stimulate the gallbladder to contract vigorously, making gallstone symptoms more pronounced.

• After a meal, you may feel pain in the right hypochondriac or epigastric region, bloating, nausea, or experience biliary colic.

Symptoms may only appear in episodes

• Not everyone with gallstones experiences pain after every meal. Some only experience symptoms when eating too much or consuming foods with high fat content.

• Pain usually appears approximately 30 minutes to several hours after eating and then subsides as the gallbladder stops contracting.

• Recording the timing of pain onset and the types of food consumed can help your doctor more easily identify the cause.

Do not be complacent when the pain is mild

• Some people only experience mild biliary colic and no signs of infection such as fever or chills. In these cases, the pain may subside on its own without needing emergency intervention.

• However, that does not mean the gallstones have healed or no monitoring is needed.

• If the pain recurs frequently, lasts longer, becomes increasingly severe, or is accompanied by fever, jaundice, or severe vomiting, you need to visit a medical facility for evaluation and timely treatment to prevent dangerous complications.

Method 4: Watch out for abdominal pain radiating to the back or shoulder

Severe pain radiating to the back or shoulder can be a sign of complications

• If gallstones cause bile duct obstruction, the gallbladder can become inflamed, leading to more severe abdominal pain than usual.

• The pain usually appears in the right hypochondriac or epigastric region, then radiates to the back or right shoulder. This is one of the signs of gallstones that needs special attention.

• Many people describe the pain as prolonged, continuous, and difficult to alleviate with rest.

Pain increases with deep breathing

• When the gallbladder is inflamed, the pain can become more pronounced with each deep breath or change in position.

• This occurs because the inflamed gallbladder is irritated when the diaphragm and abdominal muscles move during respiration.

• If you notice gallstone symptoms becoming more severe when you inhale, proactively seek early medical attention.

Pain between the shoulder blades or radiating to the right shoulder

• In addition to the abdomen, the pain can radiate to the area between the shoulder blades or concentrate in the right shoulder. This is referred pain due to nerves associated with the gallbladder.

• Because this symptom can be easily confused with neck and shoulder pain or musculoskeletal pain, many people overlook the warning signs of gallstones.

• If shoulder pain or back pain occurs along with right hypochondriac pain, nausea, or after a fatty meal, you should consider the possibility of gallstones and visit a medical facility for examination.

Do not delay seeking medical attention

• Severe abdominal pain radiating to the back or shoulder, especially when lasting for many hours or accompanied by fever, jaundice, or persistent vomiting, can be a sign of cholecystitis or dangerous complications due to gallstones.

• Early examination and diagnosis help doctors determine the appropriate treatment method, reducing the risk of infection, bile duct obstruction, or acute pancreatitis.

Method 5: Check for fever and signs of infection

Fever can be a sign of cholecystitis due to gallstones

• If you have gallstones and develop a fever, this could be a sign that the gallbladder is inflamed or infected, much more serious than typical biliary colic.

• Unlike fleeting pain, cholecystitis often causes prolonged pain, accompanied by fever, fatigue, and chills.

• When you have gallstone signs accompanied by fever, you should visit a medical facility as soon as possible for examination and treatment.

The risk of infection should not be underestimated

• About 20% of people with cholecystitis due to gallstones can develop an infection.

• Diabetic patients have a higher risk of complications due to weakened immunity and poorer infection control.

• If left untreated, the infection can progress rapidly and severely affect health.

Dangerous complications can occur

• Prolonged cholecystitis can lead to gallbladder tissue ischemia, necrosis, or even perforation of the gallbladder.

• These are all emergency complications with a risk of causing intra-abdominal infection and life-threatening if treatment is delayed.

• Therefore, do not be complacent when gallstone symptoms become more severe or abnormal signs appear.

Pay attention to signs of jaundice, yellow eyes

• If fever is accompanied by jaundice or yellowing of the whites of the eyes, it is very likely that gallstones have caused bile duct obstruction.

• Patients may also experience dark urine, pale stools, itchy skin, or progressively worsening abdominal pain.

• These are serious gallstone symptoms that require emergency care or immediate examination to limit the risk of liver damage, cholangitis, and other dangerous complications.

Part 2: Risk factors for gallstones

Factor 1: Older age increases the risk of gallstones

Risk of gallstones increases with age

• Age is one of the factors that increase the risk of gallstone formation. As the body ages, the composition of bile and the contractility of the gallbladder tend to change, creating conditions for stones to form.

• Although gallstones can occur at various ages, the risk of the disease often increases significantly after middle age.

People aged 60–70 have the highest incidence rate

• According to medical studies, the incidence of gallstones reaches its highest level in people aged 60–70.

• In this age group, gallstone signs may not be clear or can be easily confused with other digestive diseases, leading to delayed diagnosis.

• Therefore, older adults should pay attention to gallstone symptoms such as right hypochondriac pain, bloating, indigestion after eating, or prolonged nausea.

Regular check-ups are recommended for high-risk groups

• If you are over 60 years old and have additional risk factors such as obesity, diabetes, dyslipidemia, or a family history of gallstones, you should have regular health check-ups as advised by your doctor.

• Abdominal ultrasound is a simple, non-invasive, and highly valuable method for detecting gallstones even when no symptoms have appeared.

• Early detection helps with timely monitoring and treatment, reducing the risk of cholecystitis, bile duct obstruction, and other dangerous complications.

Factor 2: Women have a higher risk of gallstones

Gender affects the risk of gallstones

• Women have a higher risk of developing gallstones than men, with a ratio of about 2–3 times.

• According to studies, about 25% of women may develop gallstones before the age of 60.

• Therefore, women should proactively monitor gallstone signs, especially when there are other risk factors.

Estrogen increases the likelihood of gallstone formation

• One of the main reasons is the hormone estrogen. This hormone increases the amount of cholesterol secreted into the bile.

• When bile contains too much cholesterol, cholesterol crystals easily clump together and gradually form cholesterol gallstones, the most common type of gallstone.

• This is why women have a higher incidence of the disease than men.

Hormone therapy and birth control pills can increase the risk

• Women using hormone replacement therapy (HRT) after menopause have a higher risk of developing gallstones due to increased estrogen levels in the body.

• Some studies show that hormone therapy can increase the risk of gallstone formation by 2–3 times, depending on the type of medication, dosage, and duration of use.

• In addition, hormonal birth control pills can also contribute to an increased risk in some women due to their impact on cholesterol metabolism and gallbladder activity.

Do not stop medication on your own without medical advice

• Although hormones can increase the risk of gallstones, not all women using birth control pills or hormone therapy will develop the disease.

• If you are taking these medications and experience gallstone symptoms such as right hypochondriac pain, nausea after fatty meals, or recurrent biliary colic, please visit a medical facility for examination.

• Do not stop medication or change treatment regimens on your own without guidance from a doctor, as this can affect treatment effectiveness and overall health.

Factor 3: Pregnancy increases the risk of gallstones

Pregnant women are more prone to gallstone formation

• Pregnancy is a factor that increases the risk of gallstones due to hormonal changes and digestive system activity.

• During pregnancy, the hormone progesterone slows down gallbladder contractions, leading to bile stasis. At the same time, estrogen increases cholesterol levels in the bile, creating conditions for gallstone formation.

• Therefore, pregnant women need to pay attention to gallstone signs, especially if they have a history of gallbladder problems.

Do not ignore unusual symptoms

• If you experience gallstone symptoms such as right hypochondriac pain, biliary colic after meals, nausea, vomiting, or fever, you should seek medical attention as soon as possible.

• This could be a sign of biliary colic or cholecystitis and should be evaluated by a doctor to ensure the safety of both mother and fetus.

• Do not self-medicate with painkillers or other treatments without a healthcare professional's recommendation.

Gallstones may improve after childbirth

• In some women, gallstones or biliary sludge that formed during pregnancy may decrease or disappear after childbirth, as hormone levels return to normal and the gallbladder functions more efficiently.

• However, if gallstones cause recurrent pain, cholecystitis, or other complications, the doctor will consider appropriate treatment methods based on the health condition and stage of pregnancy.

• After birth, you should still follow up with your scheduled appointments to reassess the status of your gallstones and determine if further monitoring or treatment is needed.

Factor 4: Genetics also increases the risk of gallstones

Genetics can affect the risk of gallstones

• In addition to diet and lifestyle, genetic factors are also believed to be associated with the risk of developing gallstones.

• Some studies have reported a higher incidence of gallstones in certain ethnic groups, suggesting that genetic factors may influence cholesterol metabolism and stone formation.

• However, the risk of disease also depends on many other factors such as age, weight, diet, and underlying medical conditions.

Family history is a noteworthy sign

• If your parents, siblings, or many relatives have had gallstones, you may have a higher risk than someone without a family history.

• Nevertheless, current studies have not yet confirmed that family history is a direct cause of gallstones, but rather consider it a factor that increases the likelihood of developing the disease.

• Therefore, if you have a family member who has had the disease, you should pay more attention to gallstone symptoms and maintain a healthy lifestyle to reduce the risk.

There's no need to worry excessively if you have genetic factors

• Having a genetic factor does not mean you will definitely develop gallstones.

• Conversely, many people with no family history can still form gallstones due to obesity, a high-fat diet, rapid weight loss, diabetes, or old age.

• The important thing is to actively control modifiable risk factors, have regular health check-ups, and see a doctor if gallstone symptoms appear, such as right upper quadrant pain, biliary colic, nausea, or bloating after eating.

Factor 5: Underlying medical conditions can increase the risk of gallstones

Certain medical conditions increase the likelihood of gallstone formation

• Some chronic diseases can increase the risk of developing gallstones by affecting the production, circulation, or composition of bile.

• If you have conditions such as Crohn's disease, cirrhosis, or blood disorders (e.g., hemolytic anemia), discuss your risk of gallstones and an appropriate monitoring plan with your doctor.

• People with these conditions should pay attention to gallstone symptoms such as right upper quadrant pain, bloating, or nausea after eating.

Organ transplant and parenteral nutrition are also risk factors

• People who have undergone an organ transplant or required long-term total parenteral nutrition (TPN) are at a higher risk of forming gallstones.

• This is because the gallbladder is less stimulated to contract when food does not pass through the digestive tract, leading to bile stasis and easier stone formation.

• In these cases, doctors may recommend regular monitoring for early detection.

Diabetes increases the risk of gallbladder disease

• People with diabetes have a higher risk of gallstones as well as other gallbladder diseases.

• This risk may be related to overweight, obesity, lipid metabolism disorders, and reduced gallbladder contractility.

• Additionally, diabetic patients are at a higher risk of complications such as cholecystitis or severe infections if gallstones are not detected and treated promptly.

Proactively seek examination if you are in a high-risk group

• If you have one or more of the risk factors mentioned above, have regular health check-ups and discuss any gallstone symptoms with your doctor.

• Abdominal ultrasound is a simple, safe, and highly accurate method for detecting gallstones, even when the disease is asymptomatic.

• Early monitoring helps reduce the risk of complications such as cholecystitis, bile duct obstruction, or acute pancreatitis.

Factor 6: Lifestyle greatly affects the risk of gallstones

Overweight and rapid weight loss increase the risk of gallstones

• Overweight and obesity are among the leading risk factors for gallstones.

• When the body accumulates a lot of fat, the liver produces and excretes more cholesterol into the bile. Excess cholesterol can crystallize and form cholesterol gallstones, the most common type of gallstone.

• Many studies show that obesity can increase the risk of developing gallstones by 12–30%.

Rapid weight loss is also not beneficial

• Prolonged fasting, overly restrictive diets, or rapid weight loss can lead to poor gallbladder contraction, causing bile stasis and making stone formation more likely.

• The risk is especially high for those who lose more than 24% of their body weight or more than 1.5 kg per week in a short period.

• If you want to lose weight, you should do it gradually with a balanced diet and appropriate exercise to reduce the risk of gallstones.

A diet high in fat and cholesterol is not good for the gallbladder

• Regular consumption of foods high in saturated fat, cholesterol, and fried foods can increase the risk of gallstone formation.

• Foods such as fast food, processed meats, organ meats, and oily foods can alter bile composition, facilitating cholesterol crystallization.

• To reduce the risk, prioritize green vegetables, fruits, whole grains, fish, and unsaturated fats from nuts or vegetable oils.

Lack of physical activity is also a risk factor

• People with a sedentary lifestyle or those who sit for long periods have a higher risk of developing gallstones.

• Regular physical activity helps control weight, improves cholesterol metabolism, and supports more efficient gallbladder contraction.

• You should maintain at least 150 minutes of moderate-intensity physical activity per week, combined with a healthy diet, to reduce the risk of developing gallstone symptoms and other metabolic diseases.

Lifestyle changes effectively prevent gallstones

• Maintaining a healthy weight, losing weight scientifically, eating a balanced diet, and exercising regularly are simple but valuable measures for preventing gallstones.

• If you have multiple risk factors or have experienced gallstone symptoms, proactively seek medical attention for timely advice and monitoring to avoid complications such as cholecystitis or bile duct obstruction.

Factor 7: Some medications can increase the risk of gallstones

Some medications affect the process of gallstone formation

• In addition to factors such as age, diet, and underlying medical conditions, long-term use of certain medications can also increase the risk of developing gallstones.

• These medications can alter the composition of bile or affect the gallbladder's ability to contract, creating conditions for stones to form.

• However, not everyone who uses these medications will develop gallstones, as the risk also depends on many other factors.

Birth control pills and estrogen therapy

• Women who use hormonal birth control from an early age or receive high-dose estrogen therapy as part of hormone replacement therapy may have a higher risk of gallstones.

• Estrogen increases the amount of cholesterol in bile, thereby promoting cholesterol crystallization and stone formation.

• If you are taking these medications and experience gallstone symptoms such as right upper quadrant pain, pain after fatty meals, or nausea, you should consult your doctor.

Corticosteroids and certain specific treatments

• Prolonged use of corticosteroids or certain cancer treatment drugs (cytotoxic drugs) can increase the risk of gallstones in some individuals.

• During treatment, the doctor will weigh the benefits and risks of the medication and monitor your health if necessary.

• Patients should not stop medication or change dosages on their own without a doctor's recommendation.

Cholesterol-lowering drugs may also be related

• Some medications that lower blood cholesterol can increase the amount of cholesterol excreted into bile, thereby contributing to the formation of cholesterol gallstones in some cases.

• However, the benefits of these medications in controlling dyslipidemia and preventing cardiovascular disease often outweigh the risk of gallstone formation.

• If you are being treated for dyslipidemia and experience gallstone symptoms, inform your doctor for evaluation and adjustment of the treatment plan if needed.

Do not stop medication on your own without a doctor's order

• If you are in a high-risk group or are using the medications mentioned above, have regular health check-ups and monitor for gallstone symptoms.

• Early detection helps ensure timely treatment and reduces the risk of complications such as cholecystitis or bile duct obstruction.

• Only change or stop medication with guidance from your doctor to ensure treatment effectiveness and health safety.

Part 3: How to diagnose gallstones at the hospital

Method 1: Abdominal ultrasound to diagnose gallstones

Ultrasound is the leading method for detecting gallstones

• Abdominal ultrasound is the most commonly used method to diagnose gallstones due to its high accuracy, safety, and non-invasiveness.

• This technique allows the doctor to visualize the gallbladder and bile ducts to detect stones, assess their size, number, and location.

• In many cases, ultrasound can detect gallstones with an accuracy of about 97–98%, especially when the stones are located within the gallbladder.

How is the ultrasound procedure performed?

• During the ultrasound, a technician will apply a layer of gel to the abdominal area to help the ultrasound waves transmit better.

• The transducer will be gently moved over the abdomen to capture images of the gallbladder and surrounding organs.

• Ultrasound waves are painless, do not use X-rays, and are considered safe for most individuals, including pregnant women when indicated by a doctor.

• The entire procedure usually takes only about 15–30 minutes.

What preparations are needed before an ultrasound?

• For clearer images of the gallbladder, patients are usually asked to fast for at least 6 hours before the ultrasound.

• Fasting helps the gallbladder fill with bile, making it easier for the doctor to detect gallstones or other abnormalities.

• You may still drink a small amount of plain water if allowed by your doctor or medical facility, but you should avoid eating or consuming sugary drinks before the test.

Ultrasound helps in early detection and prevention of complications

• If you have gallstone symptoms such as right upper quadrant pain, biliary colic after meals, nausea, or prolonged bloating, ultrasound is the first step to identify the cause.

• The ultrasound results will help the doctor decide whether monitoring, medical treatment, or surgical intervention is needed, depending on the gallstone symptoms, stone size, and the risk of complications for each patient.

Method 2: CT or MRI when necessary

Doctors may order a CT scan if the ultrasound is not clear enough

• Although abdominal ultrasound is the preferred method for diagnosing gallstones, a doctor may order a computed tomography (CT) scan if the ultrasound images are unclear or if a more detailed assessment is needed.

• CT scans produce cross-sectional images of the gallbladder, liver, and bile ducts, helping to detect complications or other abnormalities in the abdomen.

• This method is typically used to aid diagnosis and is not the first choice for most cases of gallstones.

How is the CT scan procedure performed?

• During a CT scan, you will lie on a table that moves through a circular scanner.

• The machine uses X-rays combined with a computer to create detailed images of the internal organs.

• The scan usually takes about 10–30 minutes and is painless. In some cases, the doctor may order an injection of contrast dye to make the images clearer.

MRI may be used in some cases

• Instead of a CT scan, a doctor may also order a magnetic resonance imaging (MRI) scan, especially when the bile ducts need to be evaluated without using X-rays.

• MRI uses magnetic fields and radio waves to create detailed images of the liver, gallbladder, and bile ducts.

• The scan usually takes 30–60 minutes, during which the patient needs to lie still inside the machine to ensure image quality.

CT does not replace ultrasound in diagnosing gallstones

• For gallstones in the gallbladder, ultrasound remains a highly effective, cost-efficient, and preferred method.

• CT does not show a clear advantage over ultrasound in detecting common gallbladder stones.

• However, CT can be useful in some cases of suspected common bile duct stones, complications of gallstones, or when distinguishing from other causes of abdominal pain.

• The doctor will choose the appropriate diagnostic method based on the gallstone symptoms, clinical examination results, and the health status of each patient.

Method 3: Blood tests support gallstone diagnosis

Blood tests help detect inflammation and complications

• If gallstones are suspected to have caused inflammation or infection, the doctor may order blood tests to assess the health condition.

• Tests cannot directly identify gallstones, but they can detect signs of inflammation, infection, or complications related to the gallbladder and biliary tract.

• Test results will be combined with ultrasound and clinical examination to make an accurate diagnosis.

Complete Blood Count (CBC) is a commonly ordered test

• One of the common tests is a complete blood count (CBC).

• A healthcare professional will draw a small amount of blood from a vein in your arm to send to the lab.

• This is a quick, safe procedure that only causes a slight prick for a few seconds.

Indicators doctors often pay attention to

• If the white blood cell (WBC) count is elevated, this could be a sign that the body is reacting to inflammation or infection caused by gallstones.

• An elevated C-reactive protein (CRP) is also an important indicator, often seen in people with acute cholecystitis or other inflammatory conditions.

• In addition, doctors may assess electrolyte levels, liver function, and other related tests to find the cause of gallstone symptoms.

Blood tests also help detect complications

• If gallstones cause biliary obstruction or affect the pancreas, blood tests may show abnormalities such as elevated bilirubin, liver enzymes, or pancreatic enzymes.

• These results help doctors identify complications early, such as obstructive jaundice, cholangitis, or acute pancreatitis, to guide appropriate treatment.

• If you have gallstone symptoms accompanied by fever, severe abdominal pain, jaundice, or excessive vomiting, seek immediate medical attention for necessary tests and timely treatment.

Method 4: ERCP endoscopy for diagnosis and gallstone removal

ERCP is indicated when common bile duct stones are suspected

• If the doctor suspects gallstones have migrated into the common bile duct or caused biliary obstruction, you may be recommended for Endoscopic Retrograde Cholangiopancreatography (ERCP).

• This procedure helps both diagnose and treat by removing stones during the procedure, helping to relieve obstruction and reduce complications.

• ERCP is usually not indicated for the diagnosis of simple gallstones in the gallbladder, but primarily when there is suspicion of stones in the bile duct or when interventional treatment is needed.

How is the ERCP procedure performed?

• The doctor will insert a flexible endoscope through the mouth, esophagus, and stomach to the first part of the small intestine (duodenum).

• Then, a small catheter is threaded into the bile duct to inject contrast dye and take X-rays, which helps identify the location of gallstones or other abnormalities.

• If stones are found in the bile duct, the doctor can use specialized instruments to remove them or widen the opening of the bile duct during the same procedure.

Fully disclose all medications currently in use

• Before undergoing ERCP, inform your doctor about all medications you are taking, especially:

  • Diabetes medications like insulin.

  • Anticoagulants or antiplatelet drugs such as warfarin, heparin, or aspirin.

  • Hypertension medications and other prescription drugs.

• Some medications may increase the risk of bleeding or affect the procedure, so your doctor may advise adjusting the dosage or temporarily discontinuing the medication for an appropriate period.

Preparation before and after endoscopy

• ERCP is an invasive procedure, so patients are usually given sedatives or short-acting anesthesia to minimize discomfort during the procedure.

• After the procedure, you may still feel drowsy or less alert for several hours. Therefore, you should have someone drive you home and avoid driving or operating machinery on the day of the procedure.

• After ERCP, the doctor will monitor for any abnormal signs such as severe abdominal pain, fever, vomiting, or bleeding to detect rare complications early, such as acute pancreatitis, bleeding, or cholangitis.

ERCP is only performed when indicated

• Not everyone with gallstone symptoms needs to undergo ERCP.

• In most cases, doctors will prioritize ultrasound or other imaging methods first. ERCP is only considered when there is evidence or high suspicion of bile duct stones, bile duct obstruction, or when stone removal is needed for treatment.

Method 5: Liver function tests to aid diagnosis

Liver function tests can suggest gallstones

• If gallstones are suspected or if you are being evaluated for liver conditions, your doctor may order liver function tests (LFTs).

• These tests do not directly identify gallstones, but they can detect abnormalities caused by stones obstructing the bile duct or affecting liver function.

• The results are often combined with ultrasound, blood tests, and other diagnostic methods to determine the cause of gallstone symptoms.

Can be done simultaneously with blood tests

• Liver function tests are often drawn from the same blood sample as other tests, saving the patient from multiple blood draws.

• This is a simple, quick test that plays an important role in assessing the condition of the liver, gallbladder, and biliary system.

• If you have gallstone symptoms such as right upper quadrant pain, jaundice, or fever, this test will provide additional information for your doctor to make a diagnosis.

Indicators doctors often evaluate

• The doctor will review several important indicators such as:

  • Bilirubin: Increases when the bile duct is obstructed, which can cause jaundice and yellowing of the eyes.

  • Gamma-glutamyl transferase (GGT): Often increases with damage or obstruction of the bile duct.

  • Alkaline phosphatase (ALP): May increase in biliary diseases, including gallstones causing cholestasis.

• If these indicators are abnormally elevated, the doctor will consider other causes such as cholangitis, liver disease, or related disorders.

Do not rely solely on test results

• An elevated liver function index does not necessarily mean you have gallstones, as many other conditions can also cause this.

• Conversely, some people with gallstones may have completely normal liver function test results, especially when the stones are only in the gallbladder and have not caused obstruction.

• Therefore, the doctor will combine symptoms, clinical examination, and imaging methods to accurately determine the cause and choose the appropriate treatment plan.

Part 4: Effective home remedies for preventing gallstones

Tip 1: Lose weight correctly to prevent gallstones

Lose weight gradually instead of rapidly

• If you are overweight and want to reduce your risk of gallstones, prioritize gradual and sustainable weight loss.

• Prolonged fasting or adopting overly strict weight loss regimens can cause the gallbladder to contract poorly, leading to bile stasis and an increased risk of gallstone formation.

• A safe goal is to lose about 0.5–1 kg per week. This pace allows the body to adapt better and reduces the risk of developing gallstone symptoms.

Maintain a balanced diet

• Build a nutritious menu instead of completely eliminating a food group.

• Prioritize:

  • Green vegetables and fresh fruits to supplement fiber.

  • Whole grains such as brown rice, oats, whole-wheat bread, and pasta made from whole wheat.

  • Healthy protein sources like fish, poultry, beans, tofu, and low-fat dairy.

  • Good fats from olive oil, avocados, and nuts in moderation.

• Limit fried foods, processed foods, sugary drinks, and dishes high in saturated fat.

Sustainable weight loss helps protect the gallbladder

• Consistent weight loss not only helps control weight but also improves cholesterol metabolism, reducing the risk of gallstone formation.

• Combining a scientific diet with regular physical activity will provide long-term benefits and reduce the risk of weight regain.

• If you are experiencing gallstone symptoms or have been diagnosed with the condition, consult your doctor or a nutritionist to develop a weight loss plan tailored to your health status.

Tip 2: Reduce animal fats to limit gallstones

Limit foods rich in saturated fats

• A diet high in animal fats can increase cholesterol in the bile, thereby increasing the risk of gallstone formation.

• You should limit the consumption of foods such as:

  • Animal butter.

  • Fatty red meat and processed meats.

  • Cheese and full-fat dairy products.

  • Animal fat and oily fried dishes.

• Reducing these foods helps control cholesterol and reduces the risk of developing gallstone symptoms.

Prioritize healthy unsaturated fats

• Replacing saturated fats with monounsaturated fats can help improve blood lipids and reduce the risk of cholesterol gallstones, the most common type of gallstone.

• Good choices include:

  • Olive oil.

  • Canola oil.

  • Avocado.

  • Nuts and seeds.

• These foods also help increase HDL cholesterol ("good cholesterol"), contributing to better cardiovascular and digestive health.

Supplement with omega-3 rich foods

• Omega-3 fatty acids can help improve fat metabolism and reduce the risk of gallstone formation.

• You should supplement omega-3 from food sources such as:

  • Salmon, mackerel, sardines, and other fatty fish.

  • Flaxseeds and chia seeds.

  • Walnuts.

• If you need to use omega-3 supplements, consult your doctor, especially if you are being treated for chronic medical conditions or using anticoagulant medications.

Eat nuts in reasonable amounts

• Nuts like almonds, walnuts, cashews, and peanuts are rich in unsaturated fats, fiber, and beneficial micronutrients.

• Some studies show that including moderate amounts of nuts in the diet can help reduce the risk of gallstones.

• However, nuts are also energy-dense, so they should be consumed in appropriate portions to avoid weight gain.

Build a healthy diet to protect the gallbladder

• There's no need to completely eliminate fats from your diet, as fats are essential for the body and help the gallbladder contract normally.

• The key is to prioritize healthy fats, eat a variety of foods, increase green vegetables, fruits, and whole grains, and maintain a healthy weight to reduce the risk of gallstone symptoms and related complications.

Tip 3: Increase fiber intake to reduce the risk of gallstones

Supplement with 20–35 g of fiber daily

• Maintaining a fiber intake of about 20–35 g per day can help reduce the risk of gallstone formation and improve digestive health.

• Fiber helps control cholesterol, promotes bile acid excretion, and helps the digestive system function more efficiently.

• In addition to benefits for gallstones, a high-fiber diet also helps control weight, stabilize blood sugar, and reduce the risk of cardiovascular disease.

Prioritize natural fiber-rich foods

• You can supplement fiber from various food sources such as:

  • Legumes (soybeans, black beans, kidney beans, mung beans).

  • Nuts and seeds like almonds, walnuts, chia seeds, and flaxseeds.

  • Green vegetables and fresh fruits such as broccoli, leafy greens, apples, pears, oranges, and bananas.

  • Whole grains such as oats, brown rice, whole-wheat bread, and barley.

• Combining a variety of these food groups will help you easily meet your daily fiber needs.

Can use fiber supplements when needed

• If your diet does not provide enough fiber, you may consider using supplements as directed by your doctor or a nutritionist.

• For example, flaxseed meal is a good source of soluble fiber and plant-based omega-3s. You can mix about 1 full teaspoon with a glass of water or unsweetened fruit juice.

• However, supplements should not completely replace fiber from natural foods.

Increase fiber intake gradually

• When first starting to eat more fiber, gradually increase your intake over several weeks to allow your body to adapt, which helps reduce bloating or digestive discomfort.

• At the same time, drink 1.5–2 liters of water daily (or as recommended by your doctor if you have special medical conditions) to ensure fiber effectiveness and support bowel motility.

• Combining a high-fiber diet with regular exercise and maintaining a healthy weight is one of the effective ways to reduce the risk of gallstones, limit gallstone symptoms, and prevent recurrent gallstone symptoms.

Tip 4: Choose smart carbohydrates to reduce the risk of gallstones

Limit refined carbohydrates and sugar

• A diet high in sugar, sweets, sugary drinks, white bread, pasta made from refined flour, and processed foods can increase the risk of gallstones.

• When too many refined carbohydrates are consumed, the body quickly converts them into sugar, raising blood sugar and promoting cholesterol synthesis in the liver.

• Over time, excess cholesterol in the bile can crystallize and form cholesterol gallstones, the most common type of gallstone.

Prioritize whole grains and fiber-rich foods

• Instead of refined carbohydrates, choose fiber-rich carbohydrate sources such as:

  • Brown rice.

  • Oats.

  • Whole-wheat bread.

  • Barley and other whole grains.

  • Green vegetables and fresh fruits.

• These foods help stabilize blood sugar, support cholesterol control, and contribute to reducing the risk of gallstone symptoms.

Eat a balanced diet to protect your gallbladder

• You don't need to completely eliminate carbohydrates from your diet, as they are still an important energy source for the body.

• The key is to prioritize slow-absorbing, fiber-rich carbohydrates and limit foods high in added sugars.

• Combining a balanced diet with lean protein and healthy fats will help maintain normal gallbladder function and reduce the risk of gallstone symptoms.

Maintain a healthy lifestyle to reduce gallstone risk

• Some studies show that a diet too high in refined carbohydrates may be associated with a higher risk of gallstones, but this is just one of many risk factors.

• For effective prevention, you should combine a scientific diet with maintaining a healthy weight, regular exercise, and periodic health check-ups if you are in a high-risk group or have experienced gallstone symptoms.

Tip 5: Drink coffee and alcohol properly

Coffee may help reduce gallstone risk in some people

• Some studies show that drinking coffee in moderation may be associated with a reduced risk of gallstones.

• Caffeine can stimulate gallbladder contractions, which helps bile flow better and reduces stagnation – a factor contributing to stone formation.

• Additionally, coffee can positively affect cholesterol metabolism in bile in some individuals.

Not all caffeine-containing beverages have the same effect

• The benefits mentioned above are primarily noted for coffee, while other caffeinated beverages like tea or carbonated soft drinks have not shown similar efficacy in studies.

• For health benefits, prioritize pure coffee and limit adding excessive sugar, fatty cream, or syrup, as these can increase calorie intake and affect weight.

Alcohol should only be consumed in very limited amounts

• Some observational studies note that people who consume very small to moderate amounts of alcohol may have a lower risk of gallstones compared to non-drinkers or heavy drinkers.

• However, current evidence is insufficient to recommend alcohol consumption for gallstone prevention.

• Heavy alcohol consumption increases the risk of many serious diseases such as liver disease, pancreatitis, high blood pressure, cancer, and cardiovascular problems.

Do not start drinking alcohol to prevent disease

• If you do not drink alcohol, you should not start solely for the purpose of reducing the risk of gallstones, as the health risks outweigh the potential benefits.

• If you do consume alcohol, do so in moderation as recommended by your doctor and suitable for your health condition.

• To effectively prevent gallstones, proven measures such as maintaining a healthy weight, eating a high-fiber diet, limiting saturated fat, exercising regularly, and managing underlying medical conditions remain safer and more reliable options.

Not all abdominal pain is caused by gallstones

Abdominal pain can stem from various causes

• Although pain in the right upper quadrant is one of the common signs of gallstones, not all abdominal pain is related to gallstones or gallbladder disease.

• Many other diseases can cause similar symptoms, so you should not self-diagnose based solely on the location or intensity of the pain.

• Accurate diagnosis requires clinical examination, laboratory tests, and imaging methods.

Some diseases easily mistaken for gallstones

• Diseases that can cause abdominal pain similar to gallstone symptoms include:

  • Irritable bowel syndrome (IBS).

  • Ulcerative colitis.

  • Gastroesophageal reflux disease.

  • Appendicitis.

  • Diverticulitis.

  • Urinary tract infections.

  • Pneumonia, especially in the right lung.

  • Some cardiovascular diseases, including heart attack, can sometimes also cause pain in the epigastric or upper abdominal area.

When to see a doctor immediately?

• Go to a medical facility or emergency room immediately if you experience any of the following:

  • Severe or rapidly worsening abdominal pain.

  • Pain lasting for many hours and not subsiding.

  • Pain accompanied by fever and chills.

  • Jaundice (yellow skin or eyes).

  • Frequent or continuous vomiting.

  • Shortness of breath, chest pain, or dizziness.

• These could be signs of a complication due to gallstones or another emergency condition that requires timely treatment.

Do not self-medicate without knowing the cause

• If you frequently experience abdominal pain, especially after fatty meals, or suspect gallstone symptoms, see a doctor for evaluation.

• Correct diagnosis will help select the appropriate treatment method and avoid missing dangerous diseases with symptoms similar to gallstones.

References

1. National Institute of Diabetes and Digestive and Kidney Diseases. Gallstones. Bethesda, MD: U.S. Department of Health and Human Services; periodically updated.
2. American College of Gastroenterology. Guidelines for the Diagnosis and Management of Gallstone Disease. Bethesda, MD: American College of Gastroenterology.
3. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Clinical Guidelines for the Diagnosis, Treatment, and Use of Laparoscopic Techniques for Gallbladder Disease. Los Angeles, CA: SAGES.
4. 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.
5. European Society of Gastrointestinal Endoscopy (ESGE). Guideline on Endoscopic Management of Common Bile Duct Stones. Endoscopy. Most recent updated version.
6. American Society for Gastrointestinal Endoscopy (ASGE). Guideline on the Role of Endoscopy in the Evaluation and Management of Choledocholithiasis. Gastrointestinal Endoscopy. Most recent updated version.
7. World Gastroenterology Organisation (WGO). WGO Global Guidelines: Gallstone Disease. Milwaukee, WI: World Gastroenterology Organisation.
8. Merck Manual Professional Edition. Cholelithiasis (Gallstones) and Choledocholithiasis. Merck & Co., Inc.
9. MSD Manual Professional Edition. Gallstones and Biliary Tract Disorders. Merck Sharp & Dohme Corp.
10. Mayo Clinic. Gallstones: Symptoms and Causes; Gallstones: Diagnosis and Treatment. Rochester, MN: Mayo Foundation for Medical Education and Research.
11. Cleveland Clinic. Gallstones (Cholelithiasis): Symptoms, Causes, Diagnosis and Treatment. Cleveland, OH: Cleveland Clinic.
12. American College of Radiology. ACR Appropriateness Criteria® Right Upper Quadrant Pain. Reston, VA: American College of Radiology.
13. National Institute for Health and Care Excellence (NICE). Gallstone Disease: Diagnosis and Management. NICE Guideline CG188. London: National Institute for Health and Care Excellence.
14. StatPearls Publishing. Cholelithiasis. Treasure Island (FL): StatPearls Publishing; periodically updated.
15. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Elsevier. Latest edition.
16. Schwartz's Principles of Surgery. McGraw-Hill Education. Latest edition.
17. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Elsevier. Latest edition.
18. Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. Elsevier. Latest edition.
19. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. McGraw-Hill Education. Latest edition.
20. Friedman LS, Keeffe EB, eds. Handbook of Liver Disease. Elsevier. Latest edition.
    

Content edited by: Lesley Collins Tran.

Information consulted and verified by expert: Matthew Turner.