Gastritis is defined as the inflammation of the stomach’s protective inner lining, known as the mucosa. When this inflammation occurs, it commonly produces symptoms such as a gnawing or burning ache in the upper abdomen (epigastrium), nausea, or a premature feeling of fullness after eating. Because the upper abdomen houses several organs, these symptoms are not unique to gastritis. Many other conditions mimic this stomach inflammation, making professional medical evaluation necessary to determine the true cause of the pain.
Conditions Involving Ulcers and Reflux
These conditions involve physical damage or irritation to the immediate lining of the upper gastrointestinal tract. Peptic Ulcer Disease (PUD) is a deeper condition where open sores, or ulcers, form in the stomach lining (gastric ulcers) or the first part of the small intestine (duodenal ulcers). Gastritis involves general inflammation of the lining, while an ulcer is a localized break in the tissue that extends deeper than the superficial layer. This deeper erosion often results in more focused and intense pain.
A key difference in symptom presentation often relates to food intake. Pain from duodenal ulcers frequently improves after eating but returns a few hours later, while pain from gastric ulcers may worsen immediately with a meal. The primary causes for both ulcers and erosive gastritis are similar, involving long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) or infection with the bacterium Helicobacter pylori (H. pylori). The inflammation caused by H. pylori can begin as gastritis and progress to form an ulcer.
Gastroesophageal Reflux Disease (GERD) is another common mimic, resulting from stomach acid backing up into the esophagus. The defining symptom is typically heartburn, a burning sensation felt in the chest or throat. However, severe or chronic acid reflux can also present with pain localized to the upper abdomen, or epigastrium, which can easily be mistaken for stomach inflammation.
Functional Digestive Disorders
A significant number of people experience gastritis-like symptoms without any physical damage or inflammation detectable through medical testing. Functional Dyspepsia (FD) is the diagnosis given when persistent symptoms like epigastric burning, post-meal fullness, or early satiety are present, but an endoscopy reveals no ulcers, inflammation, or structural issues.
Functional dyspepsia is a disorder related to the nerves and muscles of the upper digestive tract. Symptoms may arise from a heightened sensitivity of the stomach’s nerves to normal stimuli, such as stretching after a meal. Problems with stomach motility, such as delayed emptying, are also considered a potential mechanism causing the sensation of fullness and discomfort. The distinction between FD and gastritis is fundamental: gastritis is defined by tissue inflammation, while FD is defined by symptoms without evidence of inflammation.
Pain Originating from Adjacent Organs
The upper central abdominal region is a crowded anatomical space, and pain from organs adjacent to the stomach can radiate to the epigastrium, confusing the true source of the discomfort. Gallbladder disease, such as cholecystitis or gallstones, is a frequent cause of referred pain. While gallbladder pain typically originates in the upper right quadrant of the abdomen, it can often move toward the center, directly below the breastbone.
This pain, often called biliary colic, is commonly triggered by eating fatty foods, as this stimulates the gallbladder to contract. The pain is characteristically described as intense, gripping, or gnawing, and can last from 30 minutes to several hours. Pancreatitis, which is inflammation of the pancreas, is another cause of epigastric pain that can be mistaken for gastritis. Its inflammation typically causes severe upper abdominal pain that often uniquely radiates straight through to the back.
Non-Gastrointestinal Causes
Conditions entirely outside the digestive system can manifest with pain in the upper abdomen, underscoring the need for careful diagnosis. Cardiac events, including angina or a heart attack, can present atypically as discomfort localized primarily in the epigastrium. This is particularly common in certain groups, such as women, the elderly, and those with diabetes. The pain is referred due to shared nerve pathways between the heart and the upper digestive tract, meaning the brain misinterprets the heart pain as coming from the stomach.
Beyond cardiac issues, various medications and systemic conditions can mimic gastritis by causing stomach upset. Many prescription and over-the-counter drugs have side effects that include nausea and abdominal pain. Conditions that affect the body’s systems, such as diabetes-related gastroparesis (delayed stomach emptying), can also cause chronic nausea and a sensation of fullness that closely resembles the symptoms of gastritis. If upper abdominal pain is sudden, severe, or accompanied by symptoms like shortness of breath, heavy sweating, or pain radiating to the jaw or arm, seek immediate medical attention.