Epigastric pain is located in a region of the upper abdomen. It is experienced in the area of the abdomen that is approximately in the middle, just below the nipple line. The term epigastric is in reference to an area located in the abdomen meaning “above the stomach.”
A few different things could cause this pain, as the region is comprised of a number of organs and tissues including the stomach, pancreas, duodenum, and part of the liver.
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Depending on the underlying cause of your epigastric pain, it may present differently. Some cases describe epigastric pain as a burning sensation, while others describe it as being more sharp in nature.
What causes epigastric pain?
Considering this area of the abdomen contains many different types of organs and tissues, causes of epigastric pain may vary greatly. The following are some of them:
Gastroesophageal reflux disease (GERD): Perhaps the most common cause of epigastric pain, GERD leads to a burning sensation behind the sternum that is felt in the epigastric region. GERD occurs due to the regurgitation of gastric acids back up into the esophagus.
Heartburn: Characterized by a burning sensation and is a result of high gastric acid secretions that is refluxed back into the esophagus.
Peptic ulcer disease: Due to an ulcer formation in the stomach, pain may radiate up to the epigastric area. Ulcers are often the result of an H. Pylori infection.
Gastritis: An inflammation of the stomach lining leading to epigastric pain. Weight loss and persistent nausea and vomiting may also be present.
Duodenal ulcer: Much like a peptic ulcer, this condition can also cause epigastric pain and is linked to an H. Pylori infection.
Carcinoma of the stomach: May lead to epigastric pain often accompanied by weight loss.
Pancreatitis: A common cause of epigastric pain that may even radiate to other parts of the body.
Gastroenteritis: An inflammatory condition of the stomach and intestines that leads to persistent epigastric pain. Persistent nausea, vomiting, and diarrhea are also common.
Hepatitis: Inflammation of the liver due to a viral infection that may lead to epigastric pain. Yellowish discoloration of the skin and sclera, weakness, and fever also present in chronic cases.
Symptoms that can co-exist with epigastric pain
Taking into account that more often than not, the presentation of epigastric pain is the result of an underlying condition, additional symptoms may also be present. This could include:
- Pain in the abdomen
- Frequent belching
- Constipation with alternating diarrhea
- Nausea
- Gas
- Abdominal distention
A severe cardiac condition may also mimic epigastric pain, so it is important to seek emergency medical help if you believe this to be the case. Epigastric pain in this scenario may present along with chest tightness, palpitations, and shortness of breath, with radiating pain the left arm.
Complications of epigastric pain
Usually, rare and isolated cases of epigastric pain do not lead to serious complications. However, if you suffer from chronic or long-term epigastric pain affecting your overall quality of life, it may lead to several complications down the road. If you find that your eating patterns have changed, resulting in unintentional weight loss, it is highly recommended to see a doctor right away.
Complications of epigastric pain may include:
- Cancer of the esophagus, stomach, or other organs
- Esophageal scarring and narrowing
- Myocardial infarction (heart attack), if the pain is due to angina
- Poor nutrition due to a decreased desire to eat
- Poor quality of life
How to diagnose epigastric pain
Epigastric pain can be a vague symptom, as there are many possibilities for its occurrence. Your doctor will have to ask you some questions about your epigastric pain to get a better idea of its origin. If the diagnosis is uncertain, your doctor may decide it’s necessary to do some other tests. These may include:
X-rays: Allows for a visual representation of the abdominal cavity showing the kidneys, bladder, and ureters.
Endoscopy: The use of a camera on the end of a telescopic tube allows for direct visualization inside the body. Endoscopy also has the ability to take a tissue sample if need be.
Urinalysis: To assess for a urinary tract infection or another disorder related to epigastric pain.
Blood tests: Looking for any abnormality of the organs that may signal a more insidious underlying cause of epigastric pain.
Cardiac testing: Various tests such as looking for cardiac biomarkers, a stress test, and an EEG to help identify if the heart is the cause of epigastric pain
When to visit the doctor
It is recommended to seek the aid of a medical professional if you experience severe, ongoing epigastric pain that affects daily life. If you experience any of the following, go to the emergency room right away.
- High fever
- Chest pain
- Difficulty breathing
- Passing out
- Trouble breathing or swallowing
- Throwing up blood
- Blood in your stool or black, tarry stool
By seeing your doctor, you can identify any potentially harmful underlying conditions. If some of these conditions are left untreated, it can lead to further abnormalities or even become life-threatening.
Treating epigastric pain
The cause of your epigastric pain will dictate the most effective form of therapy. Some cases of intermittent epigastric pain may not need treatment at all, with only avoidance of triggers being recommended. The treatment used for mild cases of persistent epigastric pain not due to any serious underlying condition may include the following:
Antacids: Meditation to help reduce excessive production of stomach acid.
H2 blockers: Commonly prescribed for the treatment of peptic ulcers, this form of medication prevents the formation of excessive stomach acid.
Non-steroidal anti-inflammatory drugs (NSAIDs): Used to help relieve pain as well as reduce inflammation.
Epigastric pain home remedies
While it is recommended to see a doctor if you have persistent epigastric pain, mild intermittent pain can be remedied at home using the following methods:
Aloe Vera juice: A common treatment for stomach problems. It is important not to dilute this juice in other liquids to get the full benefit.
Ginger tea: Considered an excellent treatment for the relief of stomach issues, ginger tea may help neutralize stomach acid and reduce inflamed or irritated tissue in the digestive tract.
Baking soda: Consuming a teaspoon of this powder in warm water can help neutralize the acidic nature of your stomach. If the problem persists after a few days, try two teaspoons.
Chamomile tea: A common remedy for indigestion, chamomile tea helps fight the symptoms of epigastric pain by soothing the stomach. This tea is also used to relieve heartburn.
Yogurt: Known for easing indigestion and pain caused by digestive problems. It does this by increasing the number of beneficial bacteria in the digestive tract.
Burnt toast: Used to help detoxify the stomach.
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Peppermint tea: Made from peppermint leaves, it can be a great remedy for relieving epigastric pain. However, peppermint is not recommended in cases of GERD, as it may trigger acid reflux.
Thankfully, most acute cases of epigastric pain are not serious and only require minor intervention for relief. However, chronic epigastric pain can be a sign of impending serious complications. Knowing this, it is important to recognize the signs of normal and abnormal epigastric pain and to see a doctor as soon as possible when something feels unquestionably wrong.
Related: Stomach pain after eating – causes and home remedies
Mohan Garikiparithi got his degree in medicine from Osmania University (University of Health Sciences). He practiced clinical medicine for over a decade before he shifted his focus to the field of health communications. During his active practice he served as the head of the Dept. of Microbiology in a diagnostic centre in India. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine (Homoeopathy), and other alternative systems of medicine. He now advocates treating different medical conditions without the use of traditional drugs. An ardent squash player, Mohan believes in the importance of fitness and wellness.
