Pain In Epigastrium

Epigastric pain is often connected with abdominal organs located in this area like stomach and pancreas. Even transmitted chest pain can, however, occur in this area.


Digestive tract infections

Infectious inflammations of stomach and intestines are usually accompanied by abdominal pain. Epigastric pain is typical mainly for stomach inflammation. Common infections of stomach are viral or caused by bacterial alimentary toxins, they have short duration and manifest with nausea, vomiting or diarrhea. The treatment is usually mainly hydration; in some cases antibiotics may be used.

Peptic ulcers

Pain is usually chronic and intermittent. Stomach ulcers hurt after meals when greater amount of gastric acid is released, duodenal ulcers are painful rather with empty stomach. Sharp pain in epigastrium may emerge with ulcer perforation that is followed by contraction of abdominal muscles and significant stiffening of abdominal wall. As stomach content leaks through the hole into abdominal cavity, pain starts to move down into lower abdomen. Perforated peptic ulcer is a life-threatening condition that is primarily solved by surgical intervention.

Acute pancreatitis

This is potentially a very serious condition. The most common cause is a gallstone blocking pancreatic and bile duct, or alcohol excess. Pain is intense, located epigastric or around navel and spreading to sides. The patient must be hospitalized, monitored and treated. In mild cases the procedure is rather conservative (infusion therapy, painkillers, antibiotics), serious complications such as bacterial infection of necrotic pancreatic areas need to be solved surgically. Mortality is very high in severe forms of acute pancreatitis.

Pancreatic cancer

Advanced stages of the disease are sometimes associated with significant pain that is caused by tumor growth into local neural clusters. The pain can be severe. In addition, the patient suffers from loss of appetite and weight loss. Strong painkillers are usually the only solution.

Transmitted chest pain

Epigastric pain may occur in some cases of heart attack. When bottom heart wall is affected that is in close contact with diaphragm, pain may be transmitted into upper abdomen. This includes in particular myocardial infarction. Therefore, it is appropriate to do ECG for every patient with a sudden epigastric pain.

Functional disorders

Every digestive tract symptoms may be caused by functional disorders that have no organic basis. These problems are not dangerous, but it is difficult to treat them. Diagnostic of functional disorders should be done by excluding organic conditions and diseases. Of course, in epigastric area may occur also pain caused by other abdominal organs, total list of causes can be found in article dedicated to abdominal pain.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources