Discomfort, pressure, cramping or a burning sensation felt in the upper abdomen, just below the ribs and at the lower end of the rib cage. Although people simply call it stomach pain, important organs other than the stomach, such as the gallbladder, pancreas and liver, also lie in this area.
The character of the pain, how long it lasts and when it comes on give important clues about the underlying cause.
Common Causes of Epigastric Pain
- Gastritis and peptic ulcer: Irritation of the stomach wall because of increased stomach acid or Helicobacter pylori infection. It usually shows itself as a gnawing or burning pain that gets worse when hungry.
- Gastro-oesophageal reflux: Stomach acid escaping back into the oesophagus. A burning sensation spreading up into the chest (heartburn) is typical.
- Dietary factors and intolerances: Eating too fast or too much, or very fatty, spicy or acidic food, leads to indigestion and cramps. Lactose intolerance or food poisoning can also trigger sudden cramps.
- Medicine use: Painkillers (NSAIDs — non-steroidal anti-inflammatory drugs), especially when taken on an empty stomach, weaken the stomach’s protective lining and cause pain.
- Stress and psychological factors: Intense stress and anxiety can cause uncontrolled contractions of the stomach muscles (stomach spasm).
- Problems arising from other organs: Gallstones (which affect the upper right abdomen and the back, especially after fatty meals) or inflammation of the pancreas (pancreatitis) can cause severe pain in the epigastric area.
Clues from the Type of Pain
| Type of pain | Possibly related conditions |
|---|---|
| Burning pain | Gastritis, peptic ulcer, reflux |
| Cramp or spasm | Indigestion, intense stress, wind, food poisoning |
| Pain that gets worse after eating | Gastritis, gallbladder problems |
| Worse when hungry / eased by eating | Duodenal ulcer |
When Should You See a Doctor? (Red Flags)
Although most epigastric pain comes from passing indigestion, urgent medical care is needed in some situations. If any of the following accompanies the pain, seek care at a health facility without delay:
- Vomiting blood (haematemesis) or vomiting that looks like coffee grounds
- Black, tar-like or bloody stools (melaena)
- Difficulty swallowing or pain on swallowing
- Unexplained, sudden and rapid weight loss
- Pain that worsens and spreads to the lower right side of the abdomen (suspected appendicitis)
- Shortness of breath, pallor or sweating with the pain, or pain spreading to the jaw or the left arm (a heart attack can sometimes be confused with epigastric pain)
Diagnosis and Treatment
If the complaints persist, you should see a gastroenterologist. The gold standard for a definite diagnosis is gastroscopy (endoscopy); ultrasound, blood tests and breath tests may also be used. Treatment consists of medicines that balance stomach acid (PPIs, antacids) under a doctor’s supervision, together with dietary changes.
Sources
- Prof. Ali Tüzün İnce, MD