Epigastric pain is a specific type of upper abdominal discomfort, often described as a burning, gnawing, or aching sensation. This pain is not a diagnosis in itself but rather a symptom, and it can stem from sources ranging from simple indigestion to more complex medical conditions. Understanding the location and potential origins of this symptom is the first step toward determining its cause and finding relief.
Where Epigastric Pain Occurs
The anatomical term “epigastrium” precisely defines the upper central section of the abdomen, making it the location of epigastric pain. This region sits directly beneath the rib cage and the sternum, extending downward to the area just above the umbilicus, or belly button.
This central placement means the epigastrium overlies several structures that are part of the upper digestive system. Organs such as the stomach, the duodenum (the first section of the small intestine), and parts of the liver and pancreas are situated in or immediately behind this region. Because of this density of organs, pain perceived in the epigastrium often originates from issues within these structures.
Everyday Triggers and Common Causes
Epigastric pain can frequently be attributed to transient, non-chronic issues that are often self-limiting and resolve without extensive medical intervention. One of the most common causes is functional dyspepsia, which is essentially indigestion that causes discomfort after eating. This often results from overeating, which expands the stomach beyond its typical capacity and puts temporary pressure on surrounding organs.
Another highly common trigger is acid reflux, or heartburn, where stomach acid flows backward into the esophagus. This causes a burning sensation that can be felt in the upper abdomen and chest, particularly after consuming large meals or lying down too soon after eating.
Temporary gastritis, which is a minor irritation or inflammation of the stomach lining, can also produce epigastric discomfort. This temporary irritation is frequently provoked by the consumption of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, or excessive alcohol intake.
Stress and anxiety are also recognized as contributing factors because the nervous system directly impacts digestive function. Heightened emotional states can alter the movement of the digestive muscles and increase stomach acid production, leading to a temporary sensation of pain.
Underlying Medical Conditions
Peptic Ulcer Disease (PUD) is a common cause, involving sores that develop on the lining of the stomach (gastric ulcers) or the duodenum (duodenal ulcers). The pain from an ulcer is often described as gnawing or burning and can be closely related to the timing of meals, with duodenal ulcer pain sometimes improving after eating, while gastric ulcer pain may worsen.
Chronic gastritis involves long-term inflammation of the stomach lining, frequently caused by infection with the Helicobacter pylori bacterium. This condition results in a persistent burning discomfort and may also contribute to the development of peptic ulcers over time. Gastroesophageal Reflux Disease (GERD) is a chronic form of acid reflux, where the frequent backflow of acid causes ongoing irritation and is a major source of sustained epigastric pain.
Conditions affecting organs adjacent to the epigastrium can also refer pain to this area. Gallbladder issues, such as cholecystitis or gallstones, often trigger pain that can be felt in the right upper quadrant but frequently radiates to the epigastrium. This pain typically intensifies after consuming fatty foods, which stimulate the gallbladder.
Furthermore, inflammation of the pancreas, known as pancreatitis, causes characteristic severe epigastric pain that often radiates straight through to the back. In rare but serious instances, epigastric pain can be a manifestation of referred pain from the heart, indicating cardiac ischemia or a heart attack. This occurs because the nerves supplying the heart and the digestive tract share similar pathways, confusing the brain about the pain’s true origin. This particular source of pain is more likely in individuals who have established risk factors for heart disease.
When Epigastric Pain Requires Emergency Care
Any sudden onset of crushing or severe pain should be considered an emergency. This type of intense pain can signal a serious event, such as acute pancreatitis or a perforated ulcer.
Pain that radiates significantly to other areas, particularly the jaw, neck, left arm, or back, can indicate a potential cardiac event and requires immediate evaluation. The presence of blood in vomit, known as hematemesis, or black, tarry stools, known as melena, suggests significant bleeding within the upper gastrointestinal tract.
Other concerning symptoms include severe tenderness or rigidity upon touching the abdomen, which can indicate inflammation or infection of the abdominal lining. Pain accompanied by a high fever, confusion, or difficulty breathing also warrants rapid emergency care.