Symptoms · Upper abdomen
Pain in the upper belly that goes through to the back
The short answer
Severe pain in the upper belly that goes through to the back, often with nausea or vomiting, is a warning sign. Common causes are gallstones, inflammation of the pancreas (pancreatitis) and a stomach or duodenal ulcer. In some people it comes from the heart or the main artery. This pain needs a doctor the same day. Go to the emergency room now if it is severe or lasts more than a few hours, or if it comes with vomiting, fever, yellow skin or fainting.
How patients describe it
- Pain in the upper belly going to my back
- A band of pain around my upper belly
- Pain that is worse after eating or drinking alcohol
- Pain with vomiting
- A sudden, tearing pain
Go to the emergency room now if you have
- Severe pain that does not ease, or that started suddenly
- Repeated vomiting
- Fever or chills
- Yellow eyes or skin
- A rigid, hard belly
- Chest pain, breathlessness, sweating or fainting
- Vomiting blood, or black stools
What can cause it
Gallstones or gallbladder inflammation
Pain in the upper right belly, often after fatty food, that can reach the right shoulder or back.
Next step: Ultrasound and blood tests.
Pancreatitis
Severe upper belly pain going through to the back, with vomiting. Gallstones and alcohol are common causes.
Next step: Go to the emergency room; it needs treatment in hospital.
Stomach or duodenal ulcer
Burning upper belly pain. If an ulcer bursts, the pain is sudden and severe and the belly becomes rigid.
Next step: See a doctor; a sudden severe pain needs the emergency room.
Heart or main artery problem
Sudden, tearing or crushing pain, sometimes with sweating or breathlessness.
Next step: Call an ambulance or go to the emergency room now.
What you can do now
- Do not eat or drink if the pain is severe
- Go to the emergency room, and do not drive yourself if you feel faint
- Avoid alcohol and anti-inflammatory painkillers
- Tell the team about alcohol, gallstones and all your medicines
Tests your doctor may order
- Blood tests, including liver tests and a pancreas enzyme (lipase)
- Ultrasound of the abdomen
- A CT scan, a stomach camera test, and a heart tracing (ECG) as needed
When is surgery needed?
- Pancreatitis is treated in hospital with fluids and pain control. If gallstones caused it, the gallbladder is usually removed once the pancreas has calmed down.
- An ulcer that has burst needs an emergency operation.
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Questions people ask
Can pancreatitis be dangerous?
Mild attacks usually settle with hospital care. Severe pancreatitis can be life-threatening and needs urgent treatment.
Will I need my gallbladder removed?
If gallstones caused the pancreatitis, usually yes, to stop it happening again.
Can I drink alcohol again?
Alcohol can cause pancreatitis, so ask your doctor, and avoid it while you recover.
This page gives general information and does not replace the advice of your treating team. In an emergency, go to the nearest emergency room.