The most common problem with the gallbladder is the development of gallstones — small, solid lumps that form from bile. These stones can irritate the gallbladder wall or block the flow of bile, causing pain, infection, jaundice or pancreatitis.
Another, less common issue is biliary dyskinesia, where the gallbladder or bile ducts don’t function properly, causing similar symptoms, even without stones.
Gallstones form when the balance of substances in bile changes — causing small crystals to form, which then develop into stones. The solubility of bile salts, which form these initial crystals, tends to be inherited, which is why gallstones usually run in families. Periods of dehydration, rapid weight loss or pregnancy can precipitate or accelerate the process. Some people develop one large stone, others many small ones – the size or number of stones does not usually correspond with the severity of the symptoms.
Gallstones are very common: around one-third of women and 10% of men will develop gallstones at some point, though many never have symptoms.
While genetics play the biggest role, certain factors increase the risk:
- Rapid weight loss
- Pregnancy
- Dehydration
- Certain medical conditions
You may have heard the old saying “female, fat, forty, and fertile,” but in truth, gallstones can affect almost anyone.
Gallstones can cause a range of symptoms, depending on whether they irritate the gallbladder, block the flow of bile or cause back pressure and inflammation of the pancreas.
1. Biliary Colic:
- Pain under the right ribs or across the upper abdomen as the gallbladder contracts onto stones
- May radiate to the right shoulder or back
- Often occurs after fatty meals and may wake you at night
- Usually lasts several hours
2. Cholecystitis (Infection or Inflammation):
- Similar pain, but lasting longer due to the presence of infection
- May include fever, chills, and tenderness
- Often requires antibiotics and sometimes urgent surgery
3. Cholangitis (Bile Duct Infection):
- Severe infection caused by a blocked bile duct
- Symptoms include jaundice, fever, and abdominal pain
- Requires hospital treatment and sometimes endoscopic removal of stones from the bile duct
4. Pancreatitis (Inflamed Pancreas):
- Severe upper abdominal pain
- Usually requires hospital admission
- Surgery to remove the gallbladder is recommended to prevent recurrence where pancreatitis has been caused by gallstones
Most people will need:
- Blood tests to check liver and pancreas function
- Ultrasound scan to detect gallstones
In some cases, more detailed tests like an MRI, CT scan, or endoscopic ultrasound may be needed.
Once gallstones cause pain or infection, the best long-term treatment for most patients is surgical removal of the gallbladder (cholecystectomy).
Non-surgical options (like a strict low-fat diet or medications to dissolve stones) are less effective and rarely used long-term, unless patients are not fit enough for surgery.
Most gallbladder removals are performed using keyhole (laparoscopic) surgery under general anaesthetic.
What to expect:
- Four small incisions (the largest about 1.2 cm)
- The gallbladder is carefully detached and removed
- An X-ray may be taken during surgery to check for escaped stones
- Can be performed as a day case (go home same day)
All operations carry some risk, but complications are uncommon.
- Bleeding or infection: significant problems are rare; antibiotics are given routinely
- Conversion to open surgery: around 2% or less
- Hernia at incision site: about 5%
- Temporary bloating or mild diarrhoea: affects a small number of patients, usually settles within months
As a specialist Upper GI and Hepato-Biliary Surgeon, I have performed thousands of gallbladder operations. My conversion rate is under 1%, and I have never experienced a major bile duct injury.
Weight loss drugs can affect gallstones in two ways.
Firstly, rapid weight loss, which is generally a good and healthy outcome, is unfortunately known to be a risk factor associated with the development of gallstones. Secondly, weight loss drugs themselves, such as Ozempic, Mounjaro and Wegovy can act to reduce the emptying of the gallbladder - leading to the formation of crystals of bile and then gallstones.
If you are taking weight loss medication and develop gallstones and symptoms of abdominal pain, it is worth discussing these symptoms - it may be that surgery to remove the gallbladder is required in order to continue safe weight loss therapy.
There has been some suggestion that weight loss drugs have been implicated with pancreatitis, though evidence for this is less clear and it is more likely that this effect is due to an increase in gallstones.
If you have repeated attacks of upper abdominal pain, especially after meals, or have been told you have gallstones, it’s worth seeking specialist advice.
