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Background/Aims Biliary dyspepsia presents as biliary colic in the absence of explanatory structural abnormalities. Causes include gallbladder dyskinesia, sphincter of Oddi dysfunction, biliary tract sensitivity, microscopic sludges, and duodenal hypersensitivity. However, no consensus treatment guideline exists for biliary dyspepsia. We investigated the effects of medical treatments on biliary dyspepsia. Methods We retrospectively reviewed the electronic medical records of 414 patients who had biliary pain and underwent cholescintigraphy from 2008 to 2018. We enrolled patients who received litholytic agents and underwent follow-up scans after medical treatment. We divided the patients into the GD group (biliary dyspepsia with reduced gallbladder ejection fraction [GBEF]) and the NGD group (biliary dyspepsia with normal GBEF). We compared pre- and post-treatment GBEF and symptoms. Results Of the 57 patients enrolled, 40 patients (70.2%) had significant GBEF improvement post-treatment, ranging from 34.4%±22.6% to 53.8%±26.8% (p<0.001). Fifty-two patients (91.2%) experienced significant symptom improvement (p<0.001). In the GD group (n=35), the GBEF improved significantly in 28 (80.0%) patients (range, 19.5%±11.0% to 47.9%±27.3%; p<0.001). In the NGD group (n=22), the GBEF improved in 12 (54.5%) patients, which was not significant (p=0.401). Most patients (97.1% in the GD group and 81.8% in the NGD group) had improved symptoms (p<0.001). No severe complication was reported during the treatment period. Conclusions Litholytic agents improved biliary colic in patients with biliary dyspepsia. Therefore, these agents present an alternative treatment modality for biliary dyspepsia with or without gallbladder dyskinesia. Notably, biliary colic in patients with gallbladder dyskinesia resolved after normalization of the GBEF. Further prospective and large-scale mechanistic studies are warranted. [ABSTRACT FROM AUTHOR]