Bloating due to gallstone and pain referd to upper back and chest

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"Gallstones"[MeSH Terms] AND "Biliary Colic"

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NHS gallstones symptoms urgent chest pain back pain

Gallstones can cause upper abdominal or right-sided pain that radiates to the right upper back or shoulder blade, often after a fatty meal, with nausea, vomiting, or bloating. This is often called biliary colic. But chest pain should not be assumed to be from gallstones, because heart, lung, stomach, and pancreatic problems can feel similar.

Seek emergency care now if you have chest pressure/tightness, shortness of breath, sweating, fainting, pain spreading to the jaw/left arm, or severe persistent abdominal pain. These symptoms need urgent assessment for causes beyond gallstones.

Also get urgent medical assessment today if you have:

Pain lasting more than 30 minutes or worsening
Fever, chills, repeated vomiting
Yellow eyes/skin, dark urine, or pale stools
Severe upper-abdominal pain going through to the back
A fast heartbeat or feeling very unwell

A blocked gallstone can lead to gallbladder inflammation, bile-duct infection, or pancreatitis. NHS gallstone guidance advises urgent evaluation for severe abdominal pain, vomiting, fever, jaundice, or pain spreading to the back. Gallstone pain is typically in the right upper abdomen and may radiate to the back, but bloating alone is not a reliable sign of gallstones. Sleisenger and Fordtran's Gastrointestinal and Liver Disease, p. 2398.

If you are stable and the pain has settled, arrange a prompt visit with a clinician for an abdominal ultrasound and blood tests. Repeated gallstone attacks are commonly treated with planned laparoscopic gallbladder removal. For now, avoid fatty or large meals, alcohol, and self-treating chest pain as indigestion.

Find the latest guidelines on gallstone treatment

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2025 2026 guideline management gallstone disease symptomatic cholelithiasis acute cholecystitis choledocholithiasis guideline

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"Gallstones"[MeSH Terms] AND "Practice Guideline"[Publication Type]

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"Cholecystitis, Acute"[MeSH Terms] AND "Practice Guideline"[Publication Type]

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"Gallstones"[MeSH Terms] AND "Cholecystectomy"[MeSH Terms]

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https://www.nice.org.uk/guidance/cg188/chapter/1-Recommendat…

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https://www.sages.org/publications/guidelines/guidelines-for…

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PMID: 38963820

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PMID: 36229556

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PMID: 38857482

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PMID: 42265664

Current guideline-based treatment of gallstones

The best treatment depends on whether stones are silent, causing biliary pain, or causing a complication.

Situation	Guideline-supported approach
Gallstones with no symptoms	No treatment is usually needed. Observation is appropriate unless symptoms or a specific high-risk circumstance develops. NICE guidance
Typical symptomatic gallstones / recurrent biliary colic	Offer elective laparoscopic cholecystectomy, meaning keyhole removal of the gallbladder. Day-case surgery is appropriate for many suitable patients.
Acute cholecystitis: persistent right-upper abdominal pain, tenderness, fever, inflammatory blood tests	Admit and assess. Current NICE guidance recommends early laparoscopic cholecystectomy within 1 week of diagnosis, if fit for surgery. IV fluids, pain control, and antibiotics are used when infection is suspected.
Empyema or patient too unwell for surgery	Percutaneous cholecystostomy, a drain placed into the gallbladder, may be used initially. Surgery should be reconsidered after recovery.
Common bile duct stone: jaundice, abnormal liver tests, dilated duct, cholangitis	The duct needs clearing with ERCP or surgical bile-duct exploration, plus cholecystectomy when appropriate. NICE recommends duct clearance even for incidentally found common-bile-duct stones.
Suspected but unconfirmed duct stone	Avoid diagnostic ERCP when possible. Use ultrasound and liver tests first, then MRCP or EUS for intermediate-risk cases. ERCP is usually reserved for confirmed or high-probability stones.
Gallstone pancreatitis	Hospital treatment. If there is cholangitis or ongoing obstruction, urgent ERCP may be needed. After mild biliary pancreatitis resolves, cholecystectomy is generally done during the same admission to prevent recurrence.
Pregnancy	The newer SAGES guideline favors laparoscopic cholecystectomy over non-operative treatment for symptomatic biliary disease or acute cholecystitis, with individualized decisions for uncomplicated biliary colic in the third trimester.

What is new or most relevant in current guidance

Surgery remains the standard for symptomatic disease.
Symptomatic gallstones are an indication for cholecystectomy. Sabiston Textbook of Surgery, pp. 215-220. The still-current NICE gallstone guideline specifically recommends laparoscopic cholecystectomy for symptomatic gallbladder stones.
Do not remove the gallbladder for incidental, symptom-free stones in most people.
The main exception is when a clinician identifies a separate risk-based indication.
Early rather than delayed surgery for acute cholecystitis.
NICE specifies surgery within 1 week; surgical society guidance supports early laparoscopic surgery for patients who can tolerate it.
ERCP is therapeutic, not a routine diagnostic test.
For suspected common-bile-duct stones, MRCP or EUS helps avoid unnecessary ERCP complications. The 2022 EAES guideline suggests laparoscopic common-bile-duct exploration where experienced teams are available, intraoperative ERCP if logistically feasible, and preoperative ERCP if those options are not available. EAES guideline, 2022, PMID 36229556
Evidence is evolving for uncomplicated biliary colic.
A 2026 systematic review of four randomized trials found that cholecystectomy reduced recurrent biliary pain and overall gallstone complications, while conservative management avoided surgery-related complications in selected patients. This supports shared decision-making if symptoms are mild, infrequent, or surgical risk is high. Gad et al., 2026, PMID 42265664

For your symptoms

Because you described bloating with pain referring to the upper back and chest, arrange urgent clinical assessment rather than assuming it is only gas or gallstones. Go to emergency care now for chest pressure, breathlessness, sweating, fainting, pain to jaw or arm, fever, jaundice, persistent vomiting, or severe pain that does not settle. Those symptoms can indicate acute cholecystitis, bile-duct obstruction, pancreatitis, or a non-gallbladder cause of chest pain.

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