Gallbladder stones - known medically as cholelithiasis - are one of the most common surgical conditions worldwide and a particularly heavy disease burden in north India. Most people who have gallstones never feel a thing; others have sudden severe pain after a fatty meal. Understanding what causes stones to form, and who is at higher risk, helps you decide whether to seek evaluation, what lifestyle changes might help, and when to act.

What Is the Gallbladder, and What Does Bile Do?

The gallbladder is a small, pear-shaped pouch that sits just under the liver on the right side of your upper abdomen. Its only job is to store and concentrate bile - a yellow-green digestive fluid made continuously by the liver. When you eat, especially a fatty meal, the gallbladder contracts and squirts bile through the cystic duct and common bile duct into the small intestine, where it helps break down fats into absorbable units. Bile contains water, bile salts, cholesterol, the pigment bilirubin, phospholipids (chiefly lecithin), and electrolytes. The relative amounts of cholesterol, bile salts, and lecithin determine how well bile stays liquid -and whether stones form.

The Two Main Types of Gallstones

A third, mixed-type stone - combining cholesterol and pigment - is also common and behaves like cholesterol stones in most respects.

Gallbladder Sludge: The Precursor to Stones

Before stones form, you may develop gallbladder sludge - a thick, mud-like collection of cholesterol crystals, calcium salts, and mucus in the gallbladder. Sludge is often picked up incidentally on abdominal ultrasound. Some sludge resolves on its own (particularly after pregnancy or rapid weight loss); some progresses to stones; and some can itself cause symptoms identical to stones. If you have been told you have sludge, it is worth treating it as an early warning and addressing the lifestyle risk factors described below.

Silent vs Symptomatic Gallstones - Who Will Need Treatment?

About 80% of people with gallstones never have symptoms. These "silent" stones are usually discovered incidentally on an ultrasound done for another reason. Among people with silent stones, the risk of becoming symptomatic is roughly 1-4% per year. In most cases, watchful waiting is appropriate for silent stones. Symptomatic stones - those causing biliary colic, cholecystitis, or other complications - usually require surgical removal of the gallbladder.

Read more about -Interpreting Bilirubin Test Results and Tips to Get Rid Liver Cirrhosis.

Gallstones in India: A Different Epidemiology

North vs South India - A Sevenfold Difference

Indians do not have a single national gallstone profile - the picture varies dramatically across regions. A landmark study in 1966 first showed that symptomatic gallstones were about 7 times more common in north Indian railway workers than in south Indian workers. Sixty years on, the pattern persists: community-based studies in 2025 reported gallstone disease prevalence of around 10% in Mullanpur (Punjab) and Kamprup (Assam), against 0.3% in Barshi (Maharashtra) and around 5% in south Indian cohorts (Indian community-based GSD study, 2025). The stones themselves also differ - north Indian gallstones are predominantly cholesterol or mixed; south Indian gallstones are predominantly pigment (around 83% pigment in a south Indian cadaveric series).

Why the Gangetic Belt Matters

The highest prevalence of gallstones in India is along the Gangetic basin - Uttar Pradesh, Bihar, West Bengal, Assam - and in Kashmir. The exact reasons are debated and likely combine diet (heavier in ghee, fried food, refined grains), water and soil contaminants, chronic biliary infections, and genetic predisposition. Whatever the precise mix, if you grew up in one of these regions, your individual risk is meaningfully higher than the global average.

The Gallbladder Cancer Connection

India contributes about 10% of the worldwide gallbladder cancer burden, and Delhi has the highest age-adjusted female gallbladder cancer incidence ever reported anywhere - 21.5 per 100,000. Gallstones are present in roughly 80% of Indian patients with gallbladder cancer, and the same risk factors drive both diseases. This is the most important context-specific reason for north Indian patients to take gallstones seriously: while individual cancer risk from gallstones is small in absolute terms, the regional baseline rates are very high, and large stones (over 3 cm) and porcelain gallbladder both substantially raise the cancer risk. For a Delhi-NCR patient with confirmed gallstones, a discussion with a gastroenterologist or HPB surgeon about timing of cholecystectomy is reasonable even when stones are mildly symptomatic.

The Institute for Digestive & Liver Diseases at BLK Max Hospital offers full diagnostic work-up and HPB (hepato-pancreato-biliary) surgical services for gallstone disease, including risk assessment for north Indian and Gangetic-belt patients.

Read more about - Symptoms of Gallbladder Cancer Male vs. Female and What is Cancer and Its Types.

How Do Gallstones Form? (The Pathophysiology, Simply Explained)

Stones do not appear overnight. They form through a three-step chemical process inside the gallbladder:

Step 1: Bile Becomes Supersaturated

Healthy bile holds cholesterol in solution because bile salts and lecithin act like a detergent, keeping cholesterol dispersed. If the liver secretes more cholesterol than the bile salts and lecithin can dissolve - supersaturation - the cholesterol begins to come out of solution. The same can happen with bilirubin in conditions that increase its production.

Step 2: Crystals Form (Nucleation)

Supersaturated bile first forms microscopic cholesterol monohydrate crystals (or calcium bilirubinate crystals in pigment stones). These crystals get trapped in the layer of mucus that lines the gallbladder, forming sludge.

Step 3: Stones Grow (Stasis)

If the gallbladder empties poorly - because of pregnancy, prolonged fasting, certain medications, or diabetes-related nerve dysfunction - sludge sits and crystals clump together over weeks and months into visible stones. Stones can range from a few millimetres (like a grain of rice) to several centimetres (the size of a small egg).

The Main Causes and Risk Factors

No single cause explains all gallstones - the disease arises from an interaction between bile chemistry, gallbladder function, hormones, genetics, and lifestyle. The 14 factors below are the best-established risk factors and account for the great majority of cases. Many people have several at once.

1. Female Sex and Hormones

Why it matters: women develop gallstones 2 to 3 times more often than men, particularly during the reproductive years. Oestrogen increases cholesterol secretion into bile and progesterone slows down gallbladder contraction. Both hormones together create the ideal conditions for cholesterol stones.

Who is most affected: women aged 20 to 60, women on combined oral contraceptive pills, women on hormone replacement therapy (HRT), and women who have had multiple pregnancies.

2. Pregnancy and Multiparity

Why it matters: pregnancy is a triple hit - high oestrogen, high progesterone, and slowed gallbladder emptying. Sludge develops in around 30% of pregnancies and stones in 1-4%. Most regress in the months after delivery, but some persist or grow.

Practical note: any biliary colic during pregnancy needs prompt obstetric and gastroenterology review - treatment options are limited mid-pregnancy.

3. Age (Over 40)

Why it matters: the risk of gallstones rises steadily from age 40 onwards in both sexes. The reasons are partly cumulative (decades of bile chemistry imbalance) and partly age-related changes in gallbladder motility.

4. Obesity and Metabolic Syndrome

Why it matters: being overweight or obese raises gallstone risk by a factor of 2 to 3, primarily because the liver secretes more cholesterol into bile. The risk rises with central (abdominal) obesity in particular, and is part of the metabolic syndrome cluster (abdominal obesity, hypertension, dyslipidaemia, insulin resistance).

The triglyceride-glucose index: a marker of insulin resistance - has been shown to predict gallstone development independently of BMI. Indian adults with abdominal obesity, even at a "normal" BMI, are at elevated risk because of South-Asian-specific metabolic patterns.

5. Rapid Weight Loss and Bariatric Surgery

Why it matters: losing weight quickly - through crash dieting, very-low-calorie diets, or bariatric surgery (sleeve gastrectomy, gastric bypass) - causes the liver to dump cholesterol into bile. Up to 30% of bariatric surgery patients form gallstones in the first 6 to 12 months after surgery.

Prevention: many bariatric centres now co-prescribe ursodeoxycholic acid (UDCA) for 6 months after surgery to reduce gallstone formation. If you are planning weight loss, aim for a steady 0.5 to 1 kg per week.

Practical note: the same principle applies to crash dieting, prolonged fasting, intermittent fasting taken to extremes, and very-low-calorie commercial weight-loss programmes - slow, steady loss is gallbladder-friendly.

Patients of the bariatric and weight-management programme at BLK Max Hospital are routinely counselled about gallstone risk during rapid weight loss and offered preventive medication where appropriate.

Know more about - What Are The Different Types, Procedures & Risks Of Bariatric Surgery.

6. Diabetes Mellitus

Why it matters: diabetes (type 2 in particular) raises gallstone risk through several mechanisms: insulin resistance increases cholesterol secretion into bile, autonomic neuropathy slows gallbladder emptying, and obesity and metabolic syndrome usually coexist.

Indian context: with India's adult diabetes prevalence around 11.4% and pre-diabetes a further 15%, a sizable proportion of urban Indian adults are in a higher-risk metabolic state. Controlling diabetes and managing weight tightly reduces gallstone risk along with all the more familiar cardiovascular and renal benefits.

7. Diet - High Fat, High Refined Sugar, Low Fibre

Why it matters: diets high in saturated fat, trans fat, refined sugar, refined carbohydrates, and ultra-processed foods, and low in fibre, fruit, and vegetables, increase gallstone risk.

The Indian diet pattern: frequent consumption of ghee, fried snacks (samosa, kachori, pakora), high-cholesterol sweets, refined-flour-based foods (maida), and sugar-sweetened beverages combine several risk factors in a single meal. A predominantly plant-forward Indian diet - emphasising whole grains, dals, fresh vegetables, fruit, and modest amounts of healthy fats - meaningfully reduces risk.

8. Family History and Genetics

Why it matters: about a quarter of the variation in gallstone risk between individuals is inherited. Specific gene variants - notably in the ABCG5/ABCG8 cholesterol transporters - are well-characterised, although routine genetic testing is not yet clinical practice.

Practical note: a parent, sibling, or grandparent with gallstones approximately doubles your own risk, so the threshold for ultrasound evaluation of suggestive symptoms should be lower if there is a family history.

9. Ethnicity and Geographic Origin

Why it matters: certain ethnic groups have markedly higher rates of gallstones because of inherited variation in bile cholesterol metabolism. In India, this includes north Indian and Gangetic-belt populations (see the dedicated section above). Globally, Native American populations (notably the Pima Indians of Arizona) and Hispanic populations have the highest rates; Sub-Saharan African populations the lowest.

10. Liver Disease and Cirrhosis

Why it matters: chronic liver disease - cirrhosis from any cause, including viral hepatitis B and C, alcohol, or non-alcoholic fatty liver - increases pigment stone formation significantly. Around 30% of cirrhotic patients develop gallstones. Non-alcoholic fatty liver disease (NAFLD) - extremely common in urban India - also raises risk.

Read more about - What Does the Liver Do? Tips to Keep Liver Healthy.

11. Haemolytic Disorders

Why it matters: conditions that cause increased breakdown of red blood cells generate more bilirubin, which precipitates as pigment stones. The relevant conditions include sickle cell disease, beta-thalassaemia major (an important consideration in India), hereditary spherocytosis, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and chronic haemolytic anemia.

Practical note: children and young adults with chronic haemolytic disease should be screened periodically with abdominal ultrasound - pigment stones can form early in life.

12. Crohn's Disease and Ileal Resection

Why it matters: the terminal ileum reabsorbs bile salts so they can be recycled. In Crohn's disease affecting the ileum, or after surgical removal of the terminal ileum, bile salt recycling is disrupted, bile becomes less effective at keeping cholesterol dissolved, and the risk of cholesterol stones rises. About a quarter to a third of patients with ileal Crohn's eventually develop gallstones.

13. Medications That Can Cause Gallstones

Why it matters: a small number of commonly used medications increase gallstone risk through different mechanisms.

Ceftriaxone: a widely used antibiotic, can cause "biliary pseudolithiasis" (calcium-ceftriaxone precipitates that mimic stones on ultrasound). These usually resolve when the antibiotic is stopped.

Octreotide: used for acromegaly and certain endocrine tumours - slows gallbladder emptying significantly.

Oestrogens: combined oral contraceptive pills and HRT - covered above under hormonal factors.

Fibrates (e.g., gemfibrozil): cholesterol-lowering medicines that increase cholesterol secretion into bile.

Long-term total parenteral nutrition (TPN): used in patients who cannot eat - the lack of meal-triggered gallbladder emptying allows sludge and stones to form.

GLP-1 receptor agonists (used for diabetes and weight loss - semaglutide, liraglutide, tirzepatide) have been associated with a small but real increased risk of gallstone disease in clinical trials, particularly during the rapid weight-loss phase.

14. Sedentary Lifestyle and Skipping Meals

Why it matters: physical inactivity is independently associated with higher gallstone risk. Skipping meals, prolonged fasting, and eating only once a day allow bile to sit in the gallbladder and become concentrated. Regular meals (three meals a day, or three meals and a snack) keep the gallbladder emptying regularly and reduce the risk of sludge and stones.

Recommended Reading  - Symptoms of Flatulence, Flatulence Treatment, and Gallbladder Stones Symptoms.

Gallstones in Specific Groups

Gallstones in Pregnancy

Sludge develops in around 30% of pregnancies and stones in about 1–4% (Ko & Lee, 2008). The combined effect of oestrogen (more cholesterol secreted into bile) and progesterone (slower gallbladder emptying) drives the change. Many of these resolve in the months following delivery, but some persist. A pre-existing gallbladder condition can flare up during pregnancy. Imaging during pregnancy is typically with abdominal ultrasound — safe for the baby. Surgery is sometimes needed during pregnancy itself; modern laparoscopic cholecystectomy in the second trimester is considered safe when needed.

Gallstones in Children and Adolescents

Once rare, paediatric gallstones are now increasingly recognised - driven by rising childhood obesity, the use of certain antibiotics like ceftriaxone, and, in the Indian context, chronic haemolytic anaemias including beta-thalassaemia and sickle cell disease. Any child or adolescent with right upper abdominal pain (especially after fatty meals), unexplained jaundice, or a known haemolytic disorder should have an abdominal ultrasound.

Gallstones in the Elderly

Prevalence rises with age - by 70, up to 25% of women and 15% of men have gallstones. Older patients are more likely to have complications such as acute cholecystitis, choledocholithiasis (stones in the bile duct), and gallstone pancreatitis. Symptoms can also be more atypical in older adults - vague abdominal discomfort, low-grade fever, or simply "not feeling right" - and the threshold for medical assessment should be lower.

Protective Factors: What Reduces the Risk

Not everything in the gallstone story is a risk - several factors have been associated with reduced risk in observational studies, although none should be relied on as a "prevention" in isolation:

• Moderate coffee consumption: 2-3 cups a day has been associated with lower gallstone risk, probably through caffeine's effect on gallbladder contraction.
• Regular physical activity: 30 minutes of moderate exercise on most days lowers risk, partly through weight control and partly through improved insulin sensitivity.
• Vitamin C and magnesium: higher dietary intake is associated with modestly lower risk.
• Statins: cholesterol-lowering statin medicines, taken for cardiovascular reasons, are associated with a small reduction in gallstone formation.
• Plant-forward diet: high in fruits, vegetables, whole grains, pulses, nuts, and olive oil - Mediterranean-style or DASH-style - is associated with lower risk.
• Modest alcohol consumption: observational studies suggest a small protective association, but this is not a reason to start drinking; the cardiovascular and cancer harms of alcohol outweigh any benefit.

When to Suspect Gallstones - Brief Symptom Reminder

Most gallstones are silent. When they do cause symptoms, the classic pattern is biliary colic - sudden, severe pain in the upper right abdomen or just below the breastbone, often spreading to the right shoulder or upper back, lasting from minutes to a few hours, frequently triggered by a fatty meal, sometimes accompanied by nausea and vomiting.

For a complete guide to gallstone symptoms and treatment options, see our companion articles. This page focuses on causes and prevention.

Prevention: Practical Steps That Genuinely Reduce Risk

You cannot change your genes, your sex, or your age, but you can change much of the rest. The most evidence-based preventive steps are simple and overlap with general cardiovascular and metabolic health:

Maintain a Healthy Weight (and Lose It Slowly)

Aim for a BMI in the healthy range and waist circumference within the South-Asian-specific cut-offs (less than 90 cm for men, less than 80 cm for women). If you need to lose weight, aim for 0.5 to 1 kg (about 1 to 2 pounds) per week. Crash diets and very-low-calorie programmes both increase gallstone risk.

Eat for the Gallbladder

Stay Active

Aim for at least 150 minutes of moderate-intensity activity per week - brisk walking, cycling, swimming, dancing, climbing stairs, gardening. Regular activity reduces gallstone risk independently of weight loss.

Manage Diabetes and Cholesterol

If you have diabetes, keep HbA1c at the target agreed with your doctor. Treat dyslipidaemia. The same medicines and lifestyle changes that protect the heart also reduce gallstone risk.

Don't Skip Meals

Eat at regular times. Skipping meals or prolonged fasting allows bile to sit and concentrate. Three regular meals - or three meals and a small snack - keep the gallbladder emptying. If you practise intermittent fasting, do not extend fasting windows beyond what your gallbladder tolerates; some people develop sludge or stones during prolonged fasting regimens.

Stay Hydrated

Drink enough water through the day - typically 2 to 3 litres for an adult, more in summer or during exercise. Good hydration helps keep bile flowing freely.

When to See a Doctor

Make an appointment with a gastroenterologist or HPB surgeon if you have:

• Episodes of right upper abdominal pain after fatty meals.
• Persistent indigestion, fullness, or bloating that does not settle.
• An incidental ultrasound finding of gallbladder sludge or stones.
• A family history of gallstones combined with suggestive symptoms.
• Any episode of jaundice, dark urine, pale stools, fever with chills, or severe abdominal pain - these warrant urgent emergency assessment.

At BLK Max Hospital, the Institute for Digestive & Liver Diseases and the Bariatric & Advanced Laparoscopic Surgery service offer complete evaluation for gallstone disease - ultrasound, blood work, MRCP and HIDA scans where indicated, and laparoscopic and robotic cholecystectomy when surgery is needed.

Conclusion

Gallstones are common, often silent, and rooted in a combination of bile chemistry, hormones, genetics, and lifestyle. In India - particularly in the north and the Gangetic belt - they sit alongside one of the highest baselines of gallbladder cancer in the world, which gives the diagnosis a sharper edge than in most Western contexts. You cannot change your sex, your age, or where you grew up, but most of the other major risk factors - weight, diet, physical activity, diabetes control, the pace of any weight loss, and the rhythm of your meals - are firmly within your control. If you already have stones, work with a gastroenterologist or HPB surgeon to decide between watchful waiting and surgery based on your symptoms, stone size, and individual cancer risk. If you do not have stones, the principles in this article are the same principles that protect your heart, your liver, and your metabolic future.

For evaluation, second opinion, or surgical management of gallbladder disease, book a consultation with the Institute for Digestive & Liver Diseases at BLK Max Hospital. Our team of gastroenterologists, hepatologists, and HPB surgeons provides comprehensive diagnostic work-up, minimally invasive laparoscopic and robotic cholecystectomy, and structured post-operative follow-up.

Frequently Asked Questions

1. Why do gallstones cause pain after fatty meals?

After a fatty meal, the gut releases a hormone called cholecystokinin that makes the gallbladder contract forcefully to squirt out concentrated bile. If a stone is blocking the gallbladder's outlet (the cystic duct), the forceful contraction builds pressure behind the blockage and causes the classic sudden, severe biliary colic pain in the upper right abdomen.

2. Can gallstones go away on their own?

No. Once stones have formed, they do not dissolve naturally. Occasionally a very small stone may pass into the intestine on its own, but this is unpredictable and not a treatment strategy. The underlying causes (bile chemistry, gallbladder function, lifestyle) will remain, and new stones will likely continue to form.

3. Are gallstones genetic?

Partly. Family-based and twin studies suggest around 25% of the risk is genetic. Having a first-degree relative with gallstones roughly doubles your own risk. Specific genes - particularly ABCG5/ABCG8 - are now well-characterised, though routine genetic testing is not yet standard.

4. Are gallbladder stones more common in men or women?

Women, by a factor of 2 to 3. Oestrogen increases cholesterol secretion into bile and progesterone slows gallbladder emptying, especially during the reproductive years and pregnancy.

5. Why are gallstones more common in north India than south India?

Symptomatic gallstones are about 7 times more frequent in north India than in south India, and north Indian stones are mostly cholesterol/mixed while south Indian stones are mostly pigment. Reasons likely include differences in diet (ghee, fried foods, refined grains), water and soil contaminants, chronic biliary infections, and genetic predisposition.

6. Do gallstones increase the risk of cancer?

Yes, modestly - but the absolute risk is generally low globally. In Delhi-NCR and the wider Gangetic belt, however, baseline gallbladder cancer rates are the highest in the world (Delhi has the highest female gallbladder cancer incidence ever recorded). Large stones (over 3 cm), porcelain gallbladder, and polyps over 10 mm raise cancer risk and are usually indications for surgical removal even if not very symptomatic. Discuss your specific risk with a doctor.

7. What size of gallstones is dangerous?

Danger depends on what the stones do rather than how big they are. Large stones (over 1 cm, particularly over 3 cm) are more likely to cause cholecystitis and slightly raise cancer risk. Small stones (under 5 mm) and sludge can be particularly dangerous because they can escape the gallbladder, travel down the bile duct, and lodge at the junction with the pancreas — causing gallstone pancreatitis or cholangitis.

8. What size of gallstones need surgery?

Symptoms, not size, drive the decision. Any symptomatic gallstone usually warrants cholecystectomy (gallbladder removal). For silent stones, size matters: stones over 3 cm, porcelain gallbladder, large gallbladder polyps, or stones in a patient with sickle cell disease or planned bariatric surgery are often removed even without symptoms. Your surgeon will tailor the recommendation to you.

9. Can gallstones be dissolved with medication?

A medication called ursodeoxycholic acid (UDCA) can slowly dissolve small cholesterol stones over months to years, but stones return when the medicine is stopped in most cases. UDCA is rarely used as a primary treatment; it is more commonly used as prevention during rapid weight loss after bariatric surgery, or in patients who cannot have surgery.

10. Can I live without a gallbladder?

Yes — completely normally. The gallbladder stores and concentrates bile, but is not essential. After removal, the liver continues to make bile, which trickles directly into the small intestine. Most people have no long-term effects. A small number experience mild loose stools after fatty meals for a few weeks or months, which usually settles.

11. Do gallstones come back after surgery?

Stones in the gallbladder cannot come back if the gallbladder has been removed (cholecystectomy) - there is no gallbladder for them to form in. Stones can occasionally form in the bile ducts later (choledocholithiasis), but this is uncommon. ERCP can treat duct stones without further surgery.

12. Can children get gallstones?

Yes, though they are less common than in adults. Childhood gallstones are usually linked to obesity, chronic haemolytic disorders (sickle cell, beta-thalassaemia - both important in India), certain antibiotics like ceftriaxone, or prolonged TPN. A child with right upper abdominal pain after meals should have an ultrasound.

13. Does fasting cause gallstones?

Prolonged fasting and skipping meals allow bile to sit in the gallbladder and become concentrated, which raises stone risk. Brief overnight fasting is fine; extended fasting (beyond 14–16 hours) or skipping meals consistently is not gallbladder-friendly. Aggressive intermittent-fasting regimens have been linked to higher gallstone rates in some studies.

14. Can rapid weight loss cause gallstones?

Yes - among the strongest non-genetic risk factors. The liver dumps cholesterol into bile during rapid weight loss. Up to 30% of bariatric surgery patients form gallstones in the first year. Aim for slow steady weight loss (0.5-1 kg per week); if you are having bariatric surgery, discuss preventive UDCA with your surgeon.

15. Is gallbladder removal surgery safe?

Yes - laparoscopic cholecystectomy is one of the safest and most commonly performed operations worldwide, with mortality well under 0.5% in elective settings. Most patients go home in 1-2 days and are back to normal activities within 1-2 weeks. Robotic-assisted cholecystectomy is now also available at advanced centres.

16. How are gallstones diagnosed?

Abdominal ultrasound is the first and usually the only test needed - it detects stones with about 95% sensitivity. If complications are suspected, additional tests include blood work (liver function, full blood count), CT scan, MRCP (a non-invasive MRI of the bile ducts), or HIDA scan (a functional gallbladder test).

17. Can stress cause gallstones?

Stress alone is not a direct cause. However, chronic stress is often associated with irregular meals, comfort eating, weight gain, and reduced physical activity - all of which contribute to gallstone risk. Managing stress as part of overall lifestyle change is reasonable.

18. Is coffee good or bad for gallstones?

Moderate coffee consumption (2-3 cups a day) has been associated with a lower risk of developing gallstones in several large studies, probably through caffeine's effect on gallbladder contraction. This is not a reason to start drinking coffee, but moderate consumption is safe for most people.

Disclaimer

This article is for general information only and is not a substitute for medical advice, diagnosis, or treatment. Always consult a qualified gastroenterologist, hepato-pancreato-biliary surgeon, or other healthcare professional for guidance tailored to your individual situation. Never ignore or delay seeking medical advice because of information you have read on a website.

Reference List

• Coupaye, M., Calabrese, D., Sami, O., Siauve, N., Ledoux, S., & Msika, S. (2017). Evaluation of incidence of cholelithiasis after bariatric surgery in subjects treated or not treated with ursodeoxycholic acid. Surgery for Obesity and Related Diseases, 13(4), 681–685. https://doi.org/10.1016/j.soard.2016.11.022
• Di Ciaula, A., Garruti, G., Frühbeck, G., De Bari, O., Wang, D. Q.-H., & Portincasa, P. (2019). The role of diet in the pathogenesis of cholesterol gallstones. Current Medicinal Chemistry, 26(19), 3620–3638. https://doi.org/10.2174/0929867324666170530080636
• Dutta, U., Bush, N., Kalsi, D., Popli, P., & Kapoor, V. K. (2019). Epidemiology of gallbladder cancer in India. Chinese Clinical Oncology, 8(4), 33. https://doi.org/10.21037/cco.2019.08.03
• European Association for the Study of the Liver. (2016). EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones. Journal of Hepatology, 65(1), 146–181. https://doi.org/10.1016/j.jhep.2016.03.005
• Guo, X., Shen, L., Dou, J., Liu, Y., Xu, Y., & Wang, J. (2024). Relationship of the triglyceride-glucose index with the prevalence of gallstones: A cross-sectional study. Scientific Reports, 14, Article 12345. https://doi.org/10.1038/s41598-024-67883-0