Epigastric Pain: What Can Cause Pain in Epigastric Region?

Epigastric Pain or pain in the epigastric region is a localized pain that usually occurs in the upper abdominal area just beneath the ribs. This pain is normally felt immediately after having a meal or when lying down after eating. Epigastric Pain is one of the presenting features of gastroesophageal reflux disease. This pain may also be associated with reflux where the food content may go back up towards the esophagus from the stomach resulting in pain and inflammation. Epigastric Pain is at times also associated with medical conditions like gastritis, pancreatitis, peptic ulcer disease, hiatal hernia or gallstones. Increased pressure in the abdominal area due to pregnancy can also cause Epigastric Pain. In some people this pain may be mild in nature and subside within a few minutes whereas in some people this pain may stay for long and that it sometimes interferes with the sleep of the individual. Some other associated symptoms with Epigastric Pain are abdominal bloating, constipation alternating with diarrhea, nausea and vomiting. In extremely rare cases, Epigastric Pain may also be caused due to some cardiac abnormality. Epigastric Pain normally is a benign condition and resolves on its own, although immediate medical treatment should be sought if the pain is associated with symptoms suggesting a cardiac cause to the pain like chest pain and shortness of breath.

Epigastric Pain can be caused due to many reasons. There are many medical conditions of which Epigastric Pain is a presenting symptom like GERD and the like. Below mentioned are some of the causes of Epigastric Pain.

Epigastric Pain Due To Gastroesophageal Reflux Disease (GERD): This is a medical condition in which the affected individual experiences burning feeling behind the sternal region. The main cause of this condition is backflow of the food from the stomach to the esophagus. If Epigastric Pain is caused due to GERD then the pain will worsen with bending, stooping or lying.

Peptic Ulcer Disease or PUD: Quite a few medical conditions with respect to the stomach cause Epigastric Pain of which the most common is Peptic Ulcer Disease.

Epigastric Pain Due To Acid Indigestion: Acid Indigestion also known as Heartburn also may at times cause Epigastric Pain. Heartburn causes burning sensation in the chest due to high amount of acid secretions from the stomach which regurgitates back into the esophagus causing this sensation.

Epigastric Pain Caused By Gastritis: This is a medical condition in which there is inflammation of the lining of the stomach. This causes severe pain in the Epigastric region. It may also be accompanied by weight loss and persistent nausea and vomiting.

Epigastric Pain Due To Duodenal Ulcers: This condition is also quite common in producing Epigastric Pain. These ulcers are formed due to H. Pylori. If Epigastric Pain is caused due to Duodenal Ulcer then the individual will experience pain after a couple of hours of eating a meal.

Epigastric Pain Caused Due To Carcinoma of the Stomach: Stomach Cancer is also one of the causes of Epigastric Pain. In this case, the pain will be accompanied by unintentional weight loss also.

Pancreatitis: Pancreatitis is one of the common causes of Epigastric Pain. Pancreatitis can be acute or chronic. In cases of acute pancreatitis there will be severe epigastric pain radiating towards the back and in chronic pancreatitis the pain will be rather mild in nature.

Gastroenteritis: This is an inflammatory medical condition of the stomach and the intestines. The symptoms that the patient will experience along with Epigastric Pain are pain in the abdomen, fever, persistent nausea and vomiting, and severe diarrhea.

Gallstones: Stones in the gallbladder also can cause Epigastric Pain.

Liver Dysfunctions: Medical conditions like hepatitis also can cause Epigastric Pain, although this pain will be accompanied with jaundice confirming liver involvement.

More common causes of Epigastric pain are:

• Hiatal hernia
• Persistent bouts of coughing
• Straining of abdominal muscles
• Perforated Ulcer
• Abdominal aneurysm.

Since there are many disease conditions that can cause Epigastric Pain, hence the symptoms experienced are also varied.

• Pain in the abdomen
• Abdominal distension
• Frequent belching
• Heartburn
• Constipation alternating with diarrhea
• Gas
• Nausea.

In case if an individual is experiencing Epigastric Pain along with chest tightness and palpitations along with shortness of breath and radiating pain to the left arm then the individual should seek immediate medical care as this pain may be caused due to a cardiac cause.

It is extremely vital to diagnose the underlying cause of Epigastric Pain. To do this, the treating physician will first take a detailed history and conduct a physical examination. After this, the physician will conduct the following laboratory tests to confirm the cause of Epigastric Pain.

• CBC: This test is done to check the levels of hemoglobin and hematocrit to identify the source of the pain.
• Blood Test: This is done to check the enzyme levels in the body, specifically the pancreatic enzymes to see if there is presence of pancreatitis causing Epigastric Pain, as in such cases the enzyme levels will be elevated.
• ESR: This test is done to identify the presence of inflammation in the body.

The physician may also order x-rays of the abdominal area to look for any mass causing Epigastric Pain.

In case if there is some problem with the esophagus suspected then the physician may perform an endoscopy to identify the cause of the problem.

Apart from this, other tests like urinalysis, CT scan or an MRI may be performed to look for a cause of Epigastric Pain depending on the symptoms that the patient is experiencing.

When the physician conducts a history of the patient, he or she may ask the following questions, which one needs to be aware about:

• What has been the duration of this pain?
• Is there any particular time when the pain is severe or mild?
• Is the patient suffering from lactose intolerance?
• Are there any symptoms suggestive of a cardiac abnormality being experienced?
• Are there any medications being taken?
• Where exactly is the location of the pain?

The treatment of Epigastric Pain depends on the cause of it. In cases where the pain comes and resolves within a couple of hours and there are no other accompanying symptoms then no specific treatment is required. In case if there are other symptoms being experienced along with Epigastric Pain then treatment is required. Some of the treatment options for Epigastric Pain are:

• NSAIDs To Treat Epigastric Pain: These medications are quite effective in relieving pain and discomfort as well as calming down any inflammation.
• H2 Receptor Blocking Agents For Epigastric Pain: These agents are usually prescribed for treating peptic ulcers. They also prevent formation of excessive acid in the stomach and aid in relieving heartburn symptoms as well.
• Antacids For Epigastric Pain: These medications are used to cut down excessive production of stomach acid and thus help with the pain.

Normally, mild form of Epigastric Pain is a self limiting condition and will resolve on its own in some time, although if the pain is persistent and gradually worsening and is accompanied by other symptoms as mentioned above then it is recommended to seek immediate medical evaluation to find out the cause of the pain and get treated accordingly.

Epigastric Pain usually does not lead to any complications, although it may quite a nuisance and may affect the quality of life of an individual. It can also be quite embarrassing for an individual to have pain after an official lunch or dinner. If the eating habits are changed then it may lead to weakness and weight loss which itself is quite abnormal. Hence it is recommended that you get regular checkups, and if you are under treatment for Epigastric Pain, then to follow the treatment recommendations diligently to prevent any sort of complications from Epigastric Pain.

References: