What is Epigastric Pain?
Epigastric pain is discomfort in the upper central abdomen, specifically below the ribcage and above the stomach. This area, the epigastrium, contains organs like the stomach, pancreas, and parts of the liver and small intestine. Pain here can range from minor to serious and varies in sensation (dull, sharp, burning, cramping), duration, and triggers like eating or lying down.
Common Digestive Causes of Epigastric Pain
Digestive issues are frequent causes of epigastric pain. Pain characteristics can help identify the source.
Gastroesophageal Reflux Disease (GERD) and Heartburn
Acid reflux is a common cause, felt as heartburn.
- Symptoms: Burning chest sensation extending to the throat.
- Triggers: Certain foods, drinks, overeating, or lying down after meals.
- GERD: Chronic reflux potentially damaging the esophagus.
Gastritis and Peptic Ulcers
These involve stomach or small intestine lining inflammation or sores.
- Gastritis: Stomach lining inflammation causing gnawing or burning epigastric pain. Triggers include bacteria ($H. pylori$), alcohol, and NSAIDs.
- Peptic Ulcers: Sores causing sharp or burning pain that may change with eating or an empty stomach.
Gallbladder and Pancreas Issues
Problems here can cause pain in the epigastric region, sometimes spreading to the back or shoulder.
- Gallstones: Blockages in the gallbladder causing sudden, intense upper abdominal pain, often after fatty meals.
- Pancreatitis: Pancreas inflammation with severe epigastric pain radiating to the back, potentially with nausea and vomiting.
Other Common Digestive Issues
- Indigestion (Dyspepsia): General discomfort like bloating and fullness.
- Overeating: Stomach expansion causing pain.
- Food Intolerances: Pain triggered by specific foods.
Non-Digestive Causes and Heart Concerns
Epigastric pain can also stem from non-digestive issues, including those related to the nearby heart.
Heart Attack vs. Heartburn
Distinguishing a heart attack from heartburn is vital; seek emergency care if unsure.
| Feature | Heartburn (Acid Reflux) | Heart Attack |
|---|---|---|
| Sensation | Burning sensation that travels to the chest and throat | A feeling of pressure, tightness, squeezing, or fullness in the center of the chest |
| Location of Pain | Behind the breastbone, sometimes radiating up the throat | May start in the chest and radiate to the arms, back, neck, or jaw, sometimes including the stomach |
| Triggers | Often occurs after eating or while lying down | Can be triggered by physical exertion or emotional stress |
| Associated Symptoms | Regurgitation, acidic taste in the mouth | Nausea, vomiting, sweating, shortness of breath, dizziness |
| Relief | May improve with antacids | Not relieved by antacids or changing position |
Other Non-Digestive Causes
- Musculoskeletal Issues: Pain from muscles or ribs, like costochondritis.
- Psychological Factors: Anxiety and stress can worsen discomfort.
- Pneumonia: Can cause referred pain to the upper abdomen.
When to Seek Medical Attention
While many cases are minor, some symptoms require immediate evaluation.
Call 911 immediately for epigastric pain with:
- Intense chest pressure.
- Pain radiating to arm, jaw, or back.
- Shortness of breath.
- Sweating, dizziness.
- Vomiting blood or bloody/black stools.
- Very tender or rigid abdomen.
See a doctor if pain is:
- Persistent or recurring.
- Severe and not improving.
- Accompanied by unexplained weight loss.
Diagnosis and Treatment Options
A healthcare provider will assess your symptoms and medical history.
Diagnostic Tests:
- Blood tests: To check inflammation or organ function.
- Imaging tests: Ultrasound, CT scan, X-rays for abdominal organs.
- Endoscopy: Examines the lining of the upper digestive tract.
Treatment and Management: Treatment depends on the cause. Mild cases may improve with lifestyle changes and OTC medications. More serious conditions require specific medical treatment.
Home and Lifestyle Remedies for Mild Pain:
- Dietary changes: Avoid triggers, eat smaller meals.
- Avoid lying down after eating: Helps prevent reflux.
- OTC antacids: Neutralize stomach acid.
- Stress management: Relaxation techniques can help.
- Avoid smoking and reduce alcohol: Both can irritate the stomach.
Conclusion
Epigastric pain is a common symptom with many causes, mostly digestive. However, its location near the heart means cardiac issues can present similarly. While mild cases of indigestion or reflux can often be managed with lifestyle changes, severe or persistent pain, especially with red-flag symptoms like radiating chest pain or difficulty breathing, warrants immediate medical attention. A healthcare professional is necessary for accurate diagnosis and treatment. For additional information, the Cleveland Clinic website provides details on upper abdominal pain.
