Symptoms · Upper abdomen
Pain in the upper right abdomen after eating
The short answer
Pain under the right ribs that starts after a meal, especially a fatty one, is most often caused by gallstones. It usually comes in attacks that last from about 30 minutes to a few hours and then settle. Other common causes are stomach irritation (gastritis or an ulcer) and acid reflux. See a doctor soon to find out which it is. Go to the emergency room if the pain is severe and lasts more than a few hours, or comes with fever, yellow eyes or skin, or repeated vomiting.
How patients describe it
- Pain under the right ribs
- Cramping after fatty food
- Pain in the pit of the stomach
- Pain going to the right shoulder or back
- Bloating and nausea
Go to the emergency room now if you have
- Severe pain that lasts more than a few hours (about 6), or keeps getting worse
- Fever or chills
- Yellow eyes or skin, dark urine, or pale stools
- Repeated vomiting, or you cannot keep fluids down
- Pain that goes through to your back, with vomiting
- Vomiting blood, or black stools
- Chest pain or pressure, shortness of breath, or sweating, because this can be a heart problem
Take extra care if you are pregnant, have diabetes, or have a weak immune system.
What can cause it
Gallstones (gallbladder colic)
Steady pain after a fatty meal, lasting from about 30 minutes to a few hours. It can reach the right shoulder or back.
Next step: Ultrasound of the abdomen.
Gastritis or a stomach ulcer
Burning in the upper middle belly that changes with food. It can be made worse by anti-inflammatory painkillers.
Next step: See a doctor; sometimes a stomach camera test (endoscopy).
Acid reflux
Burning behind the breastbone that is worse when lying down or bending.
Next step: Change meals and habits; see a doctor if it continues.
Fatty liver or liver inflammation
A dull ache or heaviness, but often no pain at all.
Next step: Liver blood tests and ultrasound.
Pancreatitis (urgent)
Severe upper belly pain going through to the back, with vomiting.
Next step: Go to the emergency room now.
What you can do now
- Eat smaller, lower-fat meals, and avoid fried and very fatty food
- Do not lie down for 2–3 hours after eating if you feel burning
- Avoid regular anti-inflammatory painkillers (ibuprofen, diclofenac, aspirin) unless a doctor tells you to take them
- Write down when the pain comes, what you ate, and how long it lasted, and bring this to your visit
- Book a clinic visit if attacks keep coming back, if you lose weight without trying, or if you have trouble swallowing
Tests your doctor may order
- Ultrasound of the abdomen: the first test for gallstones
- Blood tests: liver tests, a pancreas enzyme, and a blood count
- Sometimes a stomach camera test, an MRI of the bile ducts, or a CT scan
When is surgery needed?
- Gallstones that cause pain attacks or complications: removing the gallbladder by keyhole surgery is the most effective long-term treatment.
- Silent gallstones found by chance: usually no surgery is needed. About 1–2 in 100 people a year develop serious symptoms or complications, so most never need an operation.
- Other causes are treated with medicines, changes in diet and habits, or other procedures.
Related operation guides
Questions people ask
Is pain after eating always gallstones?
No. Gallstones are the most common cause of pain under the right ribs after a fatty meal, but stomach irritation, acid reflux and liver problems can feel similar. An ultrasound and a check by a doctor tell them apart.
Can gallstones go away on their own, or be dissolved with tablets?
Stones do not go away on their own. Tablets dissolve small cholesterol stones in fewer than 2 in 10 people, and the stones usually come back once the tablets are stopped.
Do I have to stop eating fat completely?
No. Smaller, lower-fat meals help while you wait for a diagnosis. Most people eat normally after the gallbladder is removed.
Is gallbladder surgery safe?
It is one of the most common operations. Serious injury to the bile duct happens in about 0.2–0.5% of operations. Your surgeon will explain the risks for you before you decide.
Is it safe to wait for an appointment?
If the attacks are mild and you have none of the emergency signs above, a short wait is usually safe. Do not ignore repeated attacks: gallstones can cause infection of the gallbladder, jaundice or pancreatitis.
This page gives general information and does not replace the advice of your treating team. In an emergency, go to the nearest emergency room.