Gallbladder attack or indigestion? How to tell the difference

A gallbladder attack usually causes steady, severe pain in the upper right or upper middle of your belly that builds quickly and lasts from about 30 minutes to several hours, sometimes spreading to your right shoulder or back. Indigestion is usually milder: a burning, full or bloated feeling that comes and goes and often eases with antacids. Fever, yellow skin or pain lasting over six hours needs urgent care.

Key takeaways

• A gallbladder attack (biliary colic) is steady, low to intense pain, not a mild discomfort that eases when you burp or pass wind.
• Gallbladder pain is most often felt under the right ribs or in the upper middle of the belly, and can spread to the right shoulder blade or back.
• Indigestion (dyspepsia) is more of a burning, bloating or early fullness feeling, and often responds to antacids.
• Both can follow a heavy or oily meal, so the type, strength and length of the pain matter more than the trigger.
• Fever, chills, yellowing of the skin or eyes, associated with this pain that will not settle are warning signs that need prompt medical attention.

What is a gallbladder attack?

A gallbladder attack is sudden pain caused when a gallstone blocks the outflow of bile from the gallbladder. The gallbladder is a small pouch under the liver that stores bile, a digestive juice that helps break down fat.

When you eat, especially a fatty meal, the gallbladder squeezes to release bile. If a stone is lodged at its outlet, the gallbladder squeezes against the blockage and pain builds. Doctors call this “biliary colic”. When the stone moves back, the pain eases, which is why attacks come in episodes. Our page about gallstones explains how stones form and who is more likely to get them.

What does indigestion feel like?

Indigestion, also called dyspepsia, is discomfort in the upper belly linked to eating. It usually feels like burning, gnawing, bloating or an uncomfortable fullness, often with burping or mild nausea.

Common triggers include large meals, eating quickly, rich or spicy food, alcohol, coffee, smoking, stress and some painkillers. Indigestion can also come from acid reflux, gastritis (inflammation of the stomach lining) or a stomach ulcer. It tends to be milder and more on and off than a gallbladder attack. If heartburn is part of the picture, KYM Surgery’s reflux site explains whether heartburn and acid reflux are the same thing.

How can you tell a gallbladder attack from indigestion?

The clearest clues are the type of pain, how strong it is, and how long it lasts. Gallbladder pain is steady and severe and does not ease with burping or antacids, while indigestion is usually a milder burning or fullness that settles more easily.

These patterns are a guide, not a diagnosis. The two can overlap, and some people with gallstones also have indigestion, so a doctor may need tests to tell them apart.

Why does gallbladder pain spread to the back or shoulder?

Pain from the gallbladder can be felt away from the organ itself because nerves from the upper belly share pathways with nerves from the shoulder and back. This is called referred pain.

Many people feel it between the shoulder blades or under the right shoulder blade, and some first assume it is a muscle strain. Our article on back pain and gallbladder problems looks at this in more detail.

When is a gallbladder attack an emergency?

A gallbladder attack becomes more serious when the blockage does not clear or infection sets in. Go to the emergency department, or call 995, if you have any of the following:

• Pain that lasts more than six hours or keeps getting worse
• Fever, chills or shivering with belly pain
• Yellowing of the skin or the whites of the eyes (jaundice)
• Dark tea-coloured urine or pale stools
• Repeated vomiting, so you cannot keep fluids down
• Severe pain spreading through to the back with vomiting, which can be a sign of pancreatitis

These can point to complications such as gallbladder inflammation or infection (cholecystitis), a stone blocking the bile duct, or inflammation of the pancreas. Read more about cholecystitis and its symptoms and how a gallbladder infection can affect your whole body.

Upper belly pain can also come from the heart. If you have chest pressure or tightness, pain spreading to the arm or jaw, breathlessness or cold sweats, call 995 straight away.

How do doctors check if it is your gallbladder?

The usual first test is an ultrasound scan of the abdomen, which can show gallstones, signs of gallbladder inflammation or dilated bile duct tube indicating a blockage from gall stone. It is quick, non-invasive and does not use radiation.

Your doctor may also order blood tests to check liver function, infection markers and pancreatic enzymes. Depending on the results, further scans such as an MRI of the bile ducts (MRCP) or a CT scan may be arranged. If indigestion seems more likely, a gastroscopy (a thin camera passed through the mouth into the stomach) may be suggested instead.

If gallstones are causing repeated attacks, your surgeon may discuss laparoscopic gallbladder surgery. Gallstones found by chance that cause no symptoms often do not need surgery, so treatment is guided by your symptoms and scan findings.

When to see a doctor

See a doctor if you have had even one episode of severe upper belly pain lasting 30 minutes or more, or if you have indigestion that keeps returning. Your GP or a polyclinic can assess you first and arrange an ultrasound or referral.

Also get checked if indigestion comes with difficulty swallowing, unplanned weight loss, vomiting, black stools or new symptoms after the age of about 50, as these need further investigation. If you have already been told you have gallstones and your attacks are becoming more frequent, you can contact KYM Surgery to arrange a consultation.

Frequently asked questions