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6 Culprits That Could Be Causing Your Upper Abdominal Pain

A lot of different things can cause stomach pain. Maybe you drank more coffee than you usually do. Or perhaps you took some medication on an empty stomach that you should have taken with food. Or you might have a case of food poisoning.

If you feel pain or discomfort in the middle or upper abdomen (stomach area), often on the left side below your ribcage, it could be something called epigastric pain. In this area of your body, you’ll find your stomach, pancreas and parts of the small intestine and liver. Conditions that affect these body parts could be causing your symptoms. 

“Epigastric pain is typically between the belly button and the ribs and it may be sharp or dull,” said Wahid Wassef, MD, a gastroenterologist with Banner – University Medicine.

Epigastric pain can feel like burning, aching or cramping. You may notice it all the time, or it may come and go. You might feel worse after you eat, drink or lie down. You might also notice heartburn, nausea, vomiting, bloating or gas. 

A lot of times, epigastric pain is mild and goes away in a few days. But if it’s severe or long-lasting, you should see your doctor to figure out what’s causing it. 

What can cause epigastric pain?

If you have pain in this area of your abdomen, it could be caused by:

  1. Gastroesophageal reflux disease and heartburn: When stomach acid backs up into your esophagus, it can cause heartburn. 
  2. Medication reaction: Some non-steroidal anti-inflammatory drugs (NSAIDs, such as Advil, Motrin, Aleve and aspirin) can irritate your stomach.
  3. Peptic ulcer disease: Your stomach might be making too much acid, which can lead to peptic ulcers. These sores develop in the lining of the stomach or small intestine. They are likely to cause pain when your stomach is empty.
  4. Infection: H. pylori bacteria can infect your stomach.
  5. Gallbladder issues: While your gallbladder is on the right side of your abdomen, gallstones and other gallbladder problems can cause pain that radiates to the epigastric region. 
  6. Pancreatitis: Inflammation of the pancreas can cause pain in this area that can radiate to your back.

What can you do to get rid of epigastric pain?

If you have mild pain, you can try making some changes to your diet and lifestyle: 

  • Eat smaller meals, so you’re not putting as much pressure on your stomach.
  • Avoid foods like coffee, chocolate, wine, tomatoes, orange juice, grapefruit juice, alcohol, spicy foods, fatty foods and acidic foods.
  • Stop taking medications that could be causing irritation.
  • Stay upright for 30 minutes after eating to help prevent stomach acid from entering the esophagus.
  • Drink plenty of fluids, which may help thin stomach acid and reduce inflammation. 
  • Get enough rest so your body can heal.
  • Maintain a healthy weight so there’s less pressure on your stomach.
  • Quit smoking since smoking can irritate your stomach lining and increase your risk of peptic ulcers. 
  • Manage stress, which triggers epigastric pain in some people. Exercise, yoga or meditation may help. 

When should you get medical help?

If lifestyle changes aren’t helping or you have any of these symptoms, you should contact your doctor or get medical care:

  • Severe pain that doesn’t respond to over-the-counter (OTC) medications. 
  • Pain that lasts for more than a few days, even if it is not severe.
  • Pain plus other symptoms like nausea, vomiting, fever or night sweats.
  • Pain that is worse after eating or drinking.
  • Pain that radiates to your back or chest. 

See your doctor right away if you are over age 50 and you have bloody stool or vomit or unexplained weight loss since these could be signs of stomach cancer. 

How is epigastric pain diagnosed?

To diagnose epigastric pain, your provider will ask you about your symptoms, when the pain started, how often it happens and how severe it is. They will also ask about your diet, lifestyle and any other medical conditions. 

They will likely feel your abdomen to check for tenderness or masses, and they may listen for bowel sounds with a stethoscope. 

Depending on your symptoms and exam, your doctor may order additional tests such as: 

  • Upper endoscopy (also called esophagogastroduodenoscopy or EGD), is a procedure where your doctor inserts a thin, flexible tube with a camera at the end into your mouth to examine your digestive tract. 
  • Biopsy, where your doctor takes a tissue sample from your stomach lining. 

Your doctor may also recommend tests to check for other conditions:

  • Blood tests to check for pancreatitis.
  • Ultrasound to check for gallstones.
  • CT scan to look for problems with your abdominal organs.

How is epigastric pain treated?

Once your provider has diagnosed what’s causing your pain, they can recommend the best course of treatment. Following your treatment plan is important for healing. 

If you have peptic disease, your doctor will probably suggest proton pump inhibitors (PPIs). They make your stomach produce less acid and can work for pain caused by peptic ulcers, GERD and other conditions. This is the most common treatment. 

In some cases, they might recommend H2 blockers, which also make your stomach produce less acid and can work for pain caused by heartburn and acid reflux. They may also suggest antacids to neutralize stomach acid, for pain caused by heartburn and acid reflux. H2 blockers and antacids are only used occasionally.

If you have an infection such as H. pylori, your doctor will prescribe antibiotics.

If your biopsy shows an inflammatory condition called intestinal metaplasia, you may need an endoscopy every two years. That’s because this condition isn’t cancerous on its own, but it could become cancer.

For gallstones, you may need surgery. 

If you have pancreatitis, your doctor will recommend bowel rest and more evaluation to figure out what’s causing it. 

In rare cases, epigastric pain is caused by stomach cancer. In that case, you would need to consult with a cancer care team for treatment options. “People of Asian descent are at higher risk of gastric cancer and could need a more thorough evaluation, even with minor symptoms,” Dr. Wassef said.

The bottom line

Epigastric pain is a pain you feel between your ribs and your belly button, usually on the left side. Mild cases often go away on their own in a few days, but severe cases need treatment. Your doctor or a Banner Health provider can diagnose the cause of epigastric pain and recommend a treatment plan. 

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