Severe Upper Abdominal Pain at Night: Could Gallstones Be the Cause?

Experiencing upper abdominal pain for two consecutive nights that wakes you up, leading to a visit to the emergency room?

Hello Doctor, a few days ago I experienced severe upper abdominal pain for two consecutive nights, waking up from the pain in my sleep.
I initially thought it was a gastric ulcer or stomach pain.
After two or three days, I underwent an endoscopy, which revealed that my stomach appeared normal with only mild inflammation.
I would like to ask if mild gastric inflammation could cause the level of pain that wakes me up in the middle of the night.
Additionally, on the same day as the endoscopy, I also had an ultrasound, which showed five gallstones.
The doctor did not mention any signs of inflammation and prescribed three medications: "Esomeprazole, Ursodiol, and a bile acid medication" to take for a week.

I have a few questions: 1.
Could the severe upper abdominal pain at night be caused by the gallstones? The pain was quite central, not specifically in the upper right quadrant (and there was no pain in my shoulder or back).
During the emergency blood tests, my total bilirubin level was 0.292.
The gallstones are approximately the size of mung beans, and is it possible for them to be dissolved and expelled through medication? How long would it take for the medication to be effective? Ultimately, will I have to undergo gallbladder removal? I am quite fearful of reaching that point, so I would like to ask about my situation.
Thank you, Doctor, for your answers!

Ms. Wu, 20~29 year old female. Ask Date: 2021/12/02

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is still possible that the gallstone is temporarily lodged.
If the pain occurs again, you can go to the emergency department for an ultrasound to confirm.
The medication is not very effective, but surgery can be considered based on the situation and is not urgently needed at this time.

Reply Date: 2021/12/02

More Info

Severe upper abdominal pain at night can indeed be caused by gallstones, even if the pain is not localized to the typical right upper quadrant where gallbladder issues are most commonly felt. The gallbladder is located beneath the liver on the right side of the abdomen, and gallstones can cause pain that radiates or is perceived in different areas of the abdomen, including the central upper region. This pain can occur when a gallstone obstructs the bile duct, leading to a condition known as biliary colic, which is characterized by intense, intermittent pain.

In your case, the fact that you experienced severe abdominal pain at night and were subsequently diagnosed with gallstones suggests that there is a possibility that the gallstones could be the source of your pain. While gastritis or mild inflammation of the stomach lining can cause discomfort, it is less likely to cause the severe, acute pain that wakes you from sleep. Gallbladder-related pain is often triggered by fatty meals, but it can also occur spontaneously.

Regarding your question about whether the gallstones can be dissolved with medication, it is important to note that while certain medications, such as ursodeoxycholic acid, can help dissolve cholesterol gallstones, this treatment is typically effective only for small stones and may take months or even years to work. The success rate is also variable, and many patients may not achieve complete dissolution of the stones. Given that you have five gallstones the size of green peas, it is unlikely that medication alone will resolve the issue effectively.

As for the concern about gallbladder removal, also known as cholecystectomy, this is a common surgical procedure performed when gallstones cause significant symptoms or complications. If your symptoms persist or worsen, or if you experience additional complications such as pancreatitis or cholangitis (infection of the bile duct), surgery may become necessary. Many patients undergo laparoscopic cholecystectomy, which is minimally invasive and has a shorter recovery time compared to open surgery.

It is understandable to feel anxious about the possibility of surgery, but it is important to weigh the risks and benefits. If gallstones are causing recurrent pain and affecting your quality of life, surgical intervention may be the best option. It is advisable to discuss your symptoms and concerns with your healthcare provider, who can help you determine the most appropriate course of action based on your specific situation.

In summary, your severe upper abdominal pain could indeed be related to gallstones, and while mild gastritis may contribute to discomfort, it is less likely to cause the level of pain you described. Medication may not effectively dissolve your gallstones, and if symptoms persist, surgical removal of the gallbladder may be necessary. It is crucial to maintain open communication with your healthcare provider to monitor your condition and make informed decisions about your treatment options.

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