When you feel pain in your stomach, it can be due to several reasons. However, the location of the pain can narrow down the possibilities and help with the diagnosis. The area between your upper abdomen and your ribs is called the epigastrium and is where you locate epigastric pain. You can also find parts of the liver, the small intestine, and the stomach in the same location.

Epigastric pain is usually described as a gnawing or burning ache. This pain can sometimes be harmless but it can also be a serious matter and even a life-threatening condition.

What causes epigastric pain?

Noting that epigastric pain can indicate an abdominal problem as well as a cardiac problem, there are numerous reasons for it.

• Indigestion: Indigestion happens after you eat a meal and your body is unable to digest it as it should. This condition could happen with anyone and is not considered dangerous. However, if it happens often, you may be allergic to an ingredient present in your food.

• Overeating: Even though each person has a different appetite, everybody has a limitation when it comes to the quantity of food they need to eat to feel full. When you overeat, you widen your stomach and pressure the organs around it which causes epigastric pain.

• Food allergies or intolerances: When a person is allergic to a certain aliment, e.g. lactose intolerant or gluten intolerant, consuming these products will lead to a very painful sensation of bloating, diarrhea, and cramping.

• Acid reflux: In order to digest the food you eat, your body needs to produce acid. Sometimes this acid comes back into the esophagus causing “acid reflux”. Along with epigastric pain, acid reflux causes chest and throat pain. When this happens in a repetitive way you may suffer from a condition called “GERD” or “Gastroesophageal Reflux Disease”. This disease should be taken seriously and treated correctly or else it can lead to more dangerous consequences such as Barrett’s esophagus.

• Drinking alcohol: Consuming too much alcohol at once or over a long period of time will upset your stomach and provoke inflammation. This will result in epigastric pain and can even cause some serious digestive issues such as ulcers.

• Esophagitis or gastritis: Esophagitis is the inflammation of the lining of the esophagus. Gastritis is the inflammation of the lining of the stomach. They are both the result of an infection, drinking, smoking, irritation by some medicines, etc. Sometimes other serious health issues may cause esophagitis and gastritis.

• Hiatal hernia: When your stomach pushes up through the diaphragm and into the chest, it is called a hiatal hernia. You can be born with an unusually large hiatus, it can be the result of a trauma to the area, or caused by an intense pressure on the abdomen cavity.

• Peptic ulcer disease: Peptic ulcer disease is the formation of sores on the inside lining of your stomach and upper portion of your small intestine. It can be due to the overuse of some medications like NSAIDs or to a bacterial infection. Peptic ulcer disease causes a burning sensation along with pain, nausea, burping, bloating, and sometimes shortness of breath.

• Gallbladder disorder: When gallstones form in the gallbladder, they block its opening. The gallbladder can also get inflamed or infected. Check for the stool’s color or yellow skin color. You can also suffer from epigastric pain, loss of appetite, gas, and bloating.

• Pregnancy: Due to the change of hormones in a pregnant women’s body, mild epigastric pain can be normal. The expansion of the womb can also aggravate this feeling. However, if the feeling persists or is severe, you should check with your doctor to make sure that it is not a more serious condition.

• Irritable bowel syndrome (IBS): IBS is a chronic condition. It affects the digestive system and causes a burning sensation along with abdominal discomfort, bloating and, cramps that may last for days.

• Cancer: Chronic epigastric pain can be serious and needs a full investigation. The patient may end up having stomach cancer, esophageal cancer, or pancreatic cancer causing this pain. Other symptoms also include fatigue, nausea, and heartburn.

• Heart Conditions: Epigastric pain doesn’t only indicate abdominal problems, but also, and more importantly, cardiac problems.

  • AAA: Abdominal Aortic Aneurysm is a life-threatening condition in which the main artery of the body is swollen and could rupture at any moment causing intensive bleeding.

  • Heart attack: epigastric pain can radiate to both left and right arm and shoulder as a sign of a heart attack.

  • Angina: is a condition in which the heart isn’t receiving enough oxygen for it to work correctly.

What are the symptoms?

Epigastric pain often comes with several other symptoms depending on the cause. The most common ones are:

• Bloating: a sensation of being full even if you have only eaten a small quantity.

• Nausea: or the sensation of wanting to vomit.

• Vomiting: if it happens regularly you may end up dehydrated.

• Burping: is your body’s way to release excess air.

• Cramps: a muscle ache that can usually go away on its own

• Burning sensation: that is associated with indigestion and GERD

• Loss of appetite: the constant pain and irritation can cause a loss of appetite as a way for the stomach to rest by not working to digest any more food.

• Heartburn: is the burning sensation that happens in your chest specifically. You can avoid it by not laying down or bending over after eating.

• Gas: is also your body’s way to release excess air however is caused by undigested food.

• Constipation: when stool becomes harder pass.

• Weight loss: if you’re in pain, have an upset stomach, and can’t eat, you may not get enough nutrients which will lead to weight loss.

Diagnosis:

To diagnose epigastric pain, the doctor will ask a series of questions about your symptoms. Where does it hurt? For how long? Is it irradiating? Are there any symptoms other than pain? A physical examination is also needed, the doctor will examine your stomach looking for masses, pain at palpation, sensitivity, or bruising. He will also check your lungs and your heart in case the pain was due to cardiac reasons. HE may also require an EKG to check the heart rhythm and electrical activity.

After it, blood tests (abdominal and cardiac tests) can be ordered. If it’s still not enough to make a diagnosis the doctor may opt for x-rays or ultrasound.

Serious conditions such as cancer require endoscopy to see the interior of the stomach, the organs, and the tissues.

How to treat epigastric pain?

Treatment depends on the reason that is triggering your pain. Multiple treatments can be suggested.

• Even though NSAIDs are generally used to relieve the pain, if they are -in this case- causing it, you have to try an alternative medicine instead such as Tylenol.

• Proton pump inhibitors (PPI), such as omeprazole can be taken first thing in the morning on an empty stomach as a form of protection to the stomach.

• Histamine blockers and PPI are used in treating GERD.

• Over-the-counter medicine can help with gastritis, indigestion, and IBS.

• Anti-acid is prescribed for acid reflux, but if it isn’t efficient your health care provider may suggest surgery.

• Surgery is necessary in the case of hernias.

• If overeating is the reason of your pain, you will have to adjust the quantities of your meals or even go on a diet.

• Serious conditions such as GERD or peptic ulcers should be managed by a healthcare specialist following a specific treatment

• Pregnant women should follow up regularly with their obstetrician.

• In the case of cancer, proper and specific treatments will be prescribed by an oncologist.

• Gallbladder disorder can be treated in two ways. For mild cases, treatment should be enough. The treatment includes medication that will dissolve the gallstones and hopefully let them out of the body through the urine. If medication doesn’t help and the case gets more serious, the patient will be suggested a cholecystectomy (removal of the gallbladder).

When to see a doctor:

You don’t always need to panic after feeling epigastric pain. Some cases are not harmful and can go away with “at home” remedies. However, if the pain lasts for more than a few days, is severe, radiating to the back or the arms, causing dyspnea, chest pain, fever or if you’re vomiting blood, you should get medical help as soon as possible to avoid a serious problem.

If you know about your risk factors like an aneurysm or gallstones you have to keep following up with your doctor in a regular way.

Preventing epigastric pain:

There is a number of things that you can do in your daily life to avoid some causes of epigastric pain.

• Stop drinking alcohol, or at least limit its consummation.

• Quit smoking, even if it takes some time to do it completely.

• Keep a healthy weight by being active regularly and commit to a normal diet plan. (You don’t need to lose weight, you just need to feed the body its sufficient nutrition).

• Eat small portions throughout the day.

• Try avoiding stress in your daily life

• Avoid medications that upset your stomach or aliments that you know are causing you discomfort (e.g. spicy food).

• If you eat at night wait at least some hours before sleeping in order for your body to fully digest your food.

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If you or anyone you know is suffering from pain, call us today on (469) 562 4188 to book an appointment with our expert doctors.