BACKGROUND/AIMS: The aim of this study was to investigate the epidemiological characteristics and changing patterns of gallstone disease over the last 20 years. METHODS: Four thousands and twenty gallstone patients who had received surgery at Seoul National University Hospital (1981~2000) were analyzed according to time of treatment; period I: 1981~1985 (831 cases), period II: 1986~1990 (888 cases), period III: 1991~1995 (1,040 cases) and period IV: 1996~ 2000 (1,261 cases). Data from 13 institutes in Korea reporting 13,101 gallstone cases were also reviewed with literature to elucidate the nation-wide trends. RESULTS: The number of gallstone cases has gradually increased. A female- predominance was not observed (F/M=1.17-1.37). The CBD stone patients were older than the GB and the IHD stone patients. Over the study period, the relative portion of the GB stone group increased. The portion of CBD stone group decreased, while that of the IHD stone group was unchanged. The rural pattern of gallstone disease (low GB stone, high CBD and IHD stone) has become similar to the urban pattern. Such patterns are well agreed with the other literature reported in Korea. CONCLUSIONS: The pattern of gallstone disease in Korea has become similar to that in Western countries except a high prevalence of hepatolithiasis.