When we suffer from stomach pain, it is almost always attributed to indigestion. However, common tummy pain could be triggered by many reasons, and identifying the exact cause is quite an elaborate process. The diagnosis begins by trying to locate the exact part of the abdominal region where it’s hurting and then looking into what is causing it. Epigastric pain is one such common stomach pain and can be caused by different factors.
Epigastric pain: pain in the upper abdomen
The epigastric region is the central region of the upper abdomen in which organs such as the stomach, small intestine, large intestine, a part of the pancreas and the left lobe of the liver are found.
“Any type of pain that arises from these four organs found in the epigastrium can lead to pain in the epigastrium region,” says Dr Rupesh Kalyan, senior consultant medical gastroenterologist at Manipal Hospitals, Bengaluru.
“Bloating, cramps, hunger pains, along with weight loss due to poor appetite, nausea and vomiting are some symptoms,” says Dr Archana Alva, specialist, emergency medicine, Aster RV Hospital, Bengaluru. “The pain experienced is dull or burning and spreads upward to the chest or the back.”
Causes of epigastric pain
Epigastric pain has both common and rare causes.
Common causes
Routine gastritis
“If a person suffers from gastritis, he or she can also experience epigastric pain due to the inflammation in the lining of the stomach,” says Dr Vipulroy Rathod, director of gastroenterology, Fortis Hospital, Mumbai.
Acid reflux or GERD (Gastroesophageal reflux disease)
In acid reflux, the acid secreted by the stomach enters the esophagus. “During an acid reflux, the individual experiences a burning sensation in the throat and will also feel like vomiting,” adds Dr Kalyan.
Gallbladder stones
The accumulation of gallbladder stones in the gallbladder or the bile duct causes severe pain. “This epigastric pain can radiate to the back as well,” adds Dr Rathod.
Peptic ulcers
“Peptic ulcers cause a burning sensation in the abdomen, which can be felt before or after eating. This is accompanied by nausea,” says Dr Kalyan.
Rare causes
Conditions like bowel ischemia, acute pancreatitis and heart attacks are the rare causes that trigger epigastric pain.
“Other rare causes of pain in the epigastrium include food pipe motility disorders. And very rarely, if those individuals who have long-standing diabetes develop a fungal infection in the food pipe, they will experience epigastric pain,” says Dr Rathod.
Diagnosing the exact cause of epigastric pain
Since the causes of epigastric pain are so varied, it is a challenge to decide whether one requires medical attention, home remedies or over-the-counter antacids.
“One of the biggest reasons for advanced stages of digestive system cancer being diagnosed in India is that people do not pay heed to their own symptoms and delay the diagnosis,” emphasises Dr Rathod.
The diagnosis of epigastric pain begins with an abdominal sonography that checks for inflammation in the pancreas, swelling in the liver or the presence of stones in the gall bladder or the bile duct.
“Once sonography has ruled out the possibility of inflammation or the presence of stones in the specific organs, one must do an ECG to rule out the possibility of a cardiac event,” says Dr Rathod. “Blood tests can help eliminate pancreatitis and other possible problems. This is followed by gastrointestinal endoscopy, a technique that allows direct visualisation of the organs like the food pipe, small intestine, etc and identification of any acid reflux-related ulcer and inflammation of the stomach. A blood test, an ECG, sonography and an upper GI endoscopy can help diagnose the cause of epigastric with an accuracy of 98-99 per cent.”
Epigastric pain treatment
Depending on the findings from the diagnosis procedure, the treatment course can be decided for epigastric pain.
“If the epigastric pain is dull and not very severe, one can take some oral antacids that might provide some relief. But if the pain is severe and persistent, then a hospital visit is mandatory,” says Dr Rathod.
“The person has to maintain a healthy lifestyle, which includes sleeping on time, eating regularly and avoiding hot liquids,” says Dr Kalyan.
“Placing a hot water bottle or a bag on the abdomen, drinking plenty of clear fluids, reducing the intake of coffee, tea and alcohol as they can aggravate the pain and taking other treatments such as antacids or even acid-blocking medicines can help relieve the pain,” suggests Dr Alva.
Takeaways
- Epigastric pain, felt in the upper region of the stomach-epigastrium region, has common causes such as acid reflux, gastritis and rare causes such as heart attack, bowel ischemia, etc.
- A blood test, an ECG, sonography and an upper GI endoscopy are used to accurately diagnose the cause of epigastric pain.
- Maintaining a healthy lifestyle, drinking plenty of fluids, placing a hot water bag on the abdomen and taking oral antacids can help relieve mild pain. But if the pain is severe, it is necessary to visit a specialist.
