Localized discomfort in the upper abdomen, below the ribs, is epigastric pain. It can be caused by a number of different things. Common gastrointestinal disturbances, such as acid reflux and indigestion, can cause epigastric pain, but serious conditions like peptic ulcers, gallstones, or even attacks of acute pancreatitis and cardiac events may be the cause. If the pain is sudden and severe, or you are short of breath, you should seek medical attention right away.
An unexpected pain in the upper stomach can be very alarming, and for good reason. It can be difficult to diagnose the cause of the pain in this region, as there are many vital organs contained in this region of the body. The pain can be a dull, constant ache for some. For others, it can be a more severe, but less frequent sharp, burning pain.
Due to the variety and broadness of epigastric pain symptoms, it is important to identify the cause in order to find the best solution. Pain can even be of a lesser, burning, more mild variety, which could even be the result of a dietary change. However, intense symptoms and epigastric pain of a severe and more compressive nature can be an emergency and need immediate medical attention.
This article provides you with the reasons for upper abdominal pain, and the epigastric pain symptoms to be especially vigilant for, and the best and most current ways to diagnose and treat the pain.
What is epigastric pain and where is it?
Epigastric pain is the discomfort located in the central region of the upper abdomen, below the rib cage. The region of the stomach where epigastric pain is located contains the major organs of digestion. These include the gall bladder, the liver, the stomach, and the pancreas.
Given the small space and density of abdominal organs, pain in this area is unsurprisingly common. Epigastric pain is mild in some and often the result of eating in a hurry or consuming overly acidic foods so nearly all people can expect to suffer episodes during their lifetime.
What causes epigastric pain in most cases?
Gastroenterologists classify the causes of epigastric pain into two broad categories: gastrointestinal causes and non-gastrointestinal causes.
Which gastrointestinal causes are responsible for pain in the upper stomach?
The most common causes of upper stomach pain are disorders of the gastrointestinal tract. The common gastrointestinal causes of epigastric pain are:
- Acid reflux and GERD: GERD occurs when there is esophageal backflow of stomachic acid. The NIH estimates that GERD occurs in 18.1% to 27.8% of the U.S. population.
- Gastritis: Gastritis is an inflammation of the gastric mucosa and can be acute or chronic. It can often result in a persistent gnawing abdominal pain.
- Peptic ulcers: Peptic ulcers are gastric or intestinal ulcers. The CDC estimates that the causative bacterium of Gastric and Duodenal Ulcers, Helicobacter pylori (H. pylori) occurs with an incidence of 80% and 90% respectively.
- Indigestion (Dyspepsia): Functional dyspepsia causes chronic pain in the upper stomach and does not have an identifiable cause. Based on a study published in Nature [Nature, 2024], the global rates of functional dyspepsia estimates the disorder affects between 6.8% and 7.2% of the population.
- Gallstones: Gallstones are formed when hardened deposits of digestive fluid obstruct the bile ducts. The American College of Gastroenterology estimates [ACG, 2021] that up to 20% of American women will develop gallstones by the age of 60.
- Pancreatitis: Inflamed pancreas creates sharp, radiating, upper abdominal, and back pain.
Can non-gastrointestinal issues cause epigastric pain?
Yes. Epigastric pain may be caused by a multitude of conditions. The close proximity of epigastric to the chest creates a pathway for non-digestive systems to be the cause of the pain.
- Cardiac issues: Epigastric pain may be caused by reduced blood flow to the heart (angina), or a heart attack.
- Musculoskeletal pain: A heavy lift that results in a strained abdominal muscle, or a severe enough cough, can cause pain that is located in the upper abdomen.
- Anxiety and stress: Psychological factors can cause upper abdominal pain and stomach cramping.
What symptoms commonly accompany epigastric pain?
Accompanying symptoms of epigastric pain are important to the diagnosis of the root cause.
What symptoms usually accompany upper abdominal pain?
Mild to moderate pain in the upper abdomen (epigastric) is often associated with an array of other digestive issues. These may include nausea, vomiting, and a sense of being overly full after starting to eat. Indigestion may be associated with bloating and excess gas. Indigestion and gastritis may also be associated with heartburn, which is a burning sensation in the chest after reflux or gastroesophageal reflux disease (GERD).
What symptoms of epigastric pain should be considered an emergency?
Severe, sudden pain in the upper abdomen that is debilitating requires immediate medical care. Abdominal pain that spreads (radiates) to the jaw, the left arm, or the back should be considered a medical emergency. Upper abdominal pain coupled with shortness of breath or difficulty breathing requires emergency medical care. Rapid, unexplained weight loss should also result in seeking medical care. Black, tarry stools or vomit that resembles coffee grounds are also epigastric pain emergencies.
How do doctors determine the cause of epigastric pain?
Doctors will determine the cause of your epigastric pain through a combination of tests and physical examinations. One of the first things your doctor will do is press on your abdomen to determine the level of tenderness and ask questions to help build your medical history.
Next diagnostic tests may be needed. A tiny camera can be passed by a gastroenterologist through an upper endoscopy to give a visual of the esophagus and stomach. To assist in determining the diagnosis of gallstones or pancreatitis, imaging tests including an abdominal ultrasound or CT scan can be administered. Additionally, elevated enzymes of the pancreas and an H. pylori infection can be diagnosed through blood, breath, and stool tests, respectively.
What is the best management and treatment strategy for epigastric pain?
It is impossible to determine the strategy for managing this pain before a diagnosis is made. The strategy is best when multifaceted and of many options.
What impact do lifestyle modifications have on the management of epigastric pain?
Even slight modifications can reduce the incidence of upper stomach pain. This can include modifications of eating smaller and more frequent meals to eating larger meals less frequently, as well as chewing food slowly and more thoroughly. Management of stress through breathing exercises or yoga can be beneficial. Lastly, less stomach lining irritation can be achieved through the avoidance of high fat and spicy foods, as well as caffeine and alcohol.
What medications can be prescribed or purchased to manage epigastric pain?
Medication can be categorized by the management of acid or infections.
- Antacids: These are helpful when there is a need for quick and mild heartburn or acid relief after a large meal.
- H2 blockers: These decrease acid production. H2 blockers can provide relief after eating a predictably spicy dinner.
- Proton pump inhibitors (PPIs): If chronic acid reflux demands extended acid blocking measures, PPIs are a good choice since PPIs block acid completely and permit healing the tissue in the esophagus.
- Prescription antibiotics: If the H. pylori test is positive, a course of antibiotics will be prescribed with the intent to eradicate the bacteria.
When is surgical intervention necessary for epigastric pain?
If medication and lifestyle changes are ineffectual to resolve epigastric pain caused by putative structural problems, surgery is warranted. Gallstones are a common example of a condition for which a cholecystectomy is frequently performed. The perforation of the stomach wall caused by a severe Peptic Ulcer is another valid example that warrants surgery to repair the ulcer.
How can you prevent epigastric pain from recurring?
Habits that focus on sustaining health perpetuate optimal function of the digestive system. Adjusting dietary habits to consuming more fiber with lean protein helps with digestion. Also helpful to digestion is regular aerobic activity that supports the movement of food throughout the digestive system. Keeping weight normal reduces the physical strain on the digestive system; thus, the risk of reflux is reduced. Finally, the most important of all the suggestions is to quit smoking, since nicotine causes the most dysfunction of the esophageal sphincter by weakening it the most.
When Should You See a Physician for Epigastric Pain?
Medical assistance should be sought when epigastric pain lasts longer than a few days. Pain that begins to worsen or intensify should be evaluated. A medical professional should evaluate trouble swallowing or early satiety. If pain in the upper abdomen compromises daily life, pain management and treatment options can be discussed.
Taking Action for Your Upper Abdominal Health
Epigastric pain can be the result of many different symptoms. Consider changes, signals, and symptoms from your body and the effect they have on your digestive system. Chronic pain and discomfort should not be tolerated. Healthcare providers can evaluate symptoms, identify and accurately diagnose the root and cause of the pain, and establish a treatment plan.
Epigastric Pain FAQ
What is the difference between epigastric pain and a heart attack?
Epigastric pain that is of a digestive origin usually worsens after eating and is relieved by the use of an antacid. A heart attack is an airway and chest pressuring pain that extends to the jaw and/or arm. It is not related to the intake of food and is accompanied by a respiratory distress and diaphoresis (sweating).
How long does epigastric pain last?
Mild pain from indigestion can last a few hours and resolve on its own. Pain caused by chronic digestive conditions, such as GERD or peptic ulcers, can last weeks to months and are resolved with intervention and treatment.
What are some of the fastest acting OTC medications with the lowest safety risk?
The safest and quickest over-the-counter options to relieve mild, occasional epigastric burning are the calcium carbonate antacids. However, they really only treat the burning symptom temporarily and shouldn’t be taken on a daily basis for over two weeks before consulting with a physician.
On average, how much does an upper endoscopy normally cost?
An upper endoscopy in the U.S. typically costs between $1500 and $3000 if the patient doesn’t have insurance, according to some of the newer healthcare cost data. If a patient does have insurance, the endoscopy cost depends on an individual’s deductible and copayment.
