Upper abdominal pain: causes, how long it lasts and when to get help

The upper abdomen is the area of the tummy below the ribs and above the navel. It contains the stomach, the first part of the small intestine, the liver, the gallbladder and bile ducts, and the pancreas. Pain here can arise from any of them, and sometimes from structures that sit nearby, such as the lower chest or the back.

NICE Clinical Knowledge Summaries uses the term dyspepsia for a complex of upper gastrointestinal symptoms, typically present for four or more weeks, which includes upper abdominal pain or discomfort, heartburn, acid reflux, nausea and vomiting. It adds that reported symptoms are a poor predictor of significant disease, which is why doctors pay close attention to alarm features and not just to the type of pain.

The table summarises pain patterns described on NHS pages. Descriptions overlap, so it is not a way to diagnose yourself.

Gastritis, the NHS says, is caused by infection with Helicobacter pylori, anti-inflammatory painkillers such as ibuprofen and aspirin, drinking too much alcohol, being very stressed and unwell, or surgery on the stomach. Stomach ulcers have the same two main causes, H. pylori infection and regular use of anti-inflammatory painkillers, and are also more common in people who smoke and in older people.

Gallstones are common and often cause no symptoms, the NHS explains. When a stone blocks a bile duct it can cause the pain called biliary colic. Acute pancreatitis is a different problem again, and symptoms can resemble appendicitis or a stomach ulcer.

The NHS also reminds people that tummy pain has many other possible sources, so persistent or unexplained pain deserves a proper assessment.

It depends on the cause, and the NHS gives different time frames for different conditions. For an ordinary stomach ache the NHS says most are not serious and go away after a few days. If pain lasts longer than that, keeps coming back or is getting worse, it is worth having checked.

NICE Clinical Knowledge Summaries describes dyspepsia as upper gastrointestinal symptoms that are typically present for four or more weeks. That is the point at which doctors start thinking about testing and treatment rather than simple lifestyle measures.

If the pain is mild and none of the warning signs below apply, the NHS pages on gastritis and stomach ulcer suggest a number of practical steps. Which ones help depends on the cause, so they are a starting point rather than a cure, and they do not replace a GP review if the pain persists.

A pharmacist can help with mild indigestion. The NHS says they can recommend antacids and alginates to stop stomach acid irritating the stomach and food pipe, or medicines such as proton pump inhibitors that reduce the amount of acid your stomach makes. Some indigestion medicines are taken after eating and some before, so check the leaflet.

Keeping a short diary of when the pain comes on, its relationship to meals, and any other symptoms helps the GP work out the cause.

• Eat smaller meals, and eat your evening meal 3 to 4 hours before going to bed (NHS stomach ulcer and gastritis pages).

• Cut back on drinks containing caffeine, such as tea, coffee, cola and energy drinks (NHS gastritis page).

• Avoid food and drink that triggers symptoms, which can include fatty or spicy foods, coffee and chocolate, and acidic or fizzy drinks (NHS).

• Do not smoke, and do not drink too much alcohol (NHS).

• Aim for a healthy weight, and take steps to manage stress (NHS).

• Speak to a doctor before taking anti-inflammatory painkillers such as ibuprofen if you have stomach symptoms, and talk to your doctor if you regularly take them or aspirin (NHS).

The NHS pages on stomach ulcer, gastritis, gallstones and pancreatitis set out similar levels of urgency.

• Call 999 or go to A&E: vomiting bright red blood or vomit like ground coffee; black, sticky and smelly poo or blood in the poo; sudden severe tummy pain; a tummy that is painful to touch; sudden chest pain; severe pain spreading to the back with being sick; yellow skin or eyes; a very high temperature or feeling hot, cold or shivery; a fast heartbeat or difficulty breathing.

• Ask for an urgent GP appointment or call NHS 111: pain that is getting worse or does not go away; loss of appetite; feeling full after a very small amount of food; losing weight without trying; a feeling of a lump in the tummy; painful or difficult swallowing; repeated vomiting; feeling tired all the time; pain lasting longer than 30 minutes that could be gallstone pain.

• See a GP in the usual way: indigestion that does not go away with treatment, tummy pain that keeps coming back, or tummy pain or indigestion lasting longer than 1 week with gastritis.

The NHS says that if a GP thinks you might have a stomach ulcer they may arrange a breath test, stool test or blood test for H. pylori, weigh you and feel your tummy, and may refer you for a gastroscopy, where a thin flexible tube with a camera passes into the stomach. Gallstones are usually checked with an ultrasound scan and a blood test. Acute pancreatitis is usually diagnosed using blood tests and sometimes a CT scan.

NICE CKS describes the assessment of unexplained dyspepsia as asking about alarm symptoms, lifestyle factors, stress, anxiety or depression, reviewing medicines such as NSAIDs, and sometimes arranging a full blood count to check for anaemia. If symptoms persist, a full-dose proton pump inhibitor for one month or testing for H. pylori may be offered, with referral for endoscopy if symptoms are refractory or recur.

For stomach ulcers the NHS lists antibiotics for H. pylori and acid-reducing medicines such as proton pump inhibitors, usually for 1 week to 2 months. For gastritis it lists antacids, proton pump inhibitors, alginates and antibiotics, and stopping or changing anti-inflammatory painkillers or alcohol where relevant. The main treatment for gallstones that cause symptoms is surgery to remove the gallbladder, with painkillers and a low-fat diet while waiting.

Acute pancreatitis needs hospital treatment with fluids, nutrients, painkillers and antibiotics if infection is present, plus treatment for the cause. The NHS says most people start getting better within a week and leave hospital in 5 to 10 days.

On the NHS most people with upper abdominal pain are first assessed by a GP, with referral for ultrasound, endoscopy or gastroenterology if needed. Urgent referral pathways exist for alarm symptoms such as swallowing difficulty or weight loss. Private gastroenterology clinics can offer faster access to gastroscopy and scans. In either route, the tests are the same, and anyone with sudden severe pain, vomiting blood or black stools should go to A&E rather than wait for a routine appointment.