Epigastric Pain: Causes, Symptoms, Complications, Diagnosis and Treatments

It manifests in a region of the upper abdomen.

It is experienced in the abdomen area in the middle, just below the nipple line. The term epigastric refers to an area in the abdomen that means “above the stomach.”

Some different reasons could cause this pain since the region comprises various organs and tissues, including the stomach, pancreas, duodenum, and part of the liver.

Depending on the underlying cause of your epigastric pain, it may present differently. Some cases describe epigastric pain as a burning sensation, while others describe it as more acute.

What is the epigastrium?

Epigastrium is found in the upper part of the abdomen, just above the stomach. The epigastric region includes the stomach, a part of the liver, the pancreas, and the duodenum.

What is epigastric pain?

Epigastric pain occurs in the upper abdominal area just below the ribs. It occurs mainly when the gastric components tend to move up towards the back of the throat, causing the person to feel a burning sensation and inflammation.

The pain is usually felt immediately after eating or going to bed directly. The nature of the pain can vary from mild to severe at times.


It is pretty standard in pregnant women due to increased pressure in the abdominal area and various hormonal changes that slow down the digestive process.

Epigastric pain is felt in the middle of the upper abdomen, just below the rib cage. Occasional epigastric pain is usually not a concern and can be as simple as a stomach ache from eating harmful foods.

There are many common digestive problems associated with epigastric pain and other underlying conditions that can cause pain in that area.

Severe cases can be life-threatening, and it is essential to work with a doctor to understand the difference between a simple cause of epigastric pain and a more serious underlying condition.

Is this a cause for concern?

Epigastric pain often occurs along with other common symptoms of your digestive system. These symptoms may include heartburn, bloating, and gas.

Epigastric pain is not always a cause for concern. This condition has many possible reasons, mainly when it occurs right after eating.

It is essential to differentiate between pain caused by something harmless, such as overeating or lactose intolerance, and pain due to an underlying condition, such as gastroesophageal reflux, inflammation, or infection.

What causes epigastric pain?

Different diseases can cause this pain, so it is difficult to determine the exact reason. Considering that this abdomen area contains many other organs and tissues, the causes of epigastric pain can vary greatly. The following are some of them:

Epigastric pain in pregnancy: mild epigastric pain is joint during pregnancy due to the pressure exerted by the growing pregnancy on the abdominal area. It is also expected due to changes in your hormones and your digestion. You may also experience frequent heartburn while you are pregnant.

However, significant epigastric pain in pregnancy is sometimes a symptom of a severe illness known as preeclampsia. It requires close monitoring by your doctor and can endanger life if it is challenging.

You will need careful observation, blood pressure checks, blood tests, and urinalysis to rule out this as a cause of epigastric pain.

Acid reflux: occurs when part of the stomach acid or food in your stomach returns to your esophagus. When this happens, it can cause pain in the chest and throat. Over time, constant acid reflux can cause gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD): Perhaps the most common cause of epigastric pain, gastroesophageal reflux disease produces a burning sensation behind the sternum that is felt in the epigastric region.

Gastroesophageal reflux disease occurs due to the regurgitation of gastric acids in the esophagus.

Stomach acidity is characterized by a burning sensation and results from high secretions of gastric acid that are refluxed back into the esophagus.

Peptic ulcer disease: due to an ulcer formation in the stomach, the pain can radiate to the epigastric area. Ulcers are often the result of H. pylori infection.

Esophagitis: occurs when the lining of the esophagus becomes inflamed. Common causes include acid that comes back up from the stomach, allergies, infection or chronic irritation of medications. If not treated, esophagitis can cause scarring of the esophagus lining.

Barrett’s esophagus: occurs when the tissue lining the esophagus begins to look more like the tissue lining the intestines. This is called intestinal metaplasia. This condition requires close monitoring.

Untreated, Barrett’s esophagus can cause cancer of the esophagus. Gastroesophageal reflux disease, smoking, alcohol consumption, and obesity are also risk factors for this type of cancer.

Gastritis: inflammation of the lining of the stomach that causes epigastric pain. There may also be weight loss and persistent nausea and vomiting.

Duodenal ulcer: This condition can also cause epigastric pain related to H. pylori infection like a peptic ulcer.

Carcinoma of the stomach: can cause epigastric pain, often accompanied by weight loss.

Pancreatitis: a common cause of epigastric pain that can even radiate to other parts of the body.

Gastroenteritis: An inflammatory condition of the stomach and intestines that leads to persistent epigastric pain. Constant nausea, vomiting, and diarrhea are also common.

Hepatitis: inflammation of the liver due to a viral infection that can cause epigastric pain. Yellowish discoloration of the skin and sclera, weakness, and fever also occur in chronic cases.

Indigestion ( dyspepsia ): is a name for the digestive symptoms that occur when you eat foods that do not seem to agree with you. You will feel bloated, with many belches, fill up even if you have not eaten much, and have nausea and pressure in the abdomen due to gas.

Lactose intolerance: occurs when your body has problems digesting dairy products, such as milk or cheese. All dairy products contain a type of sugar called lactose. Usually, the symptoms will occur each time you eat dairy products.

Lactose intolerance often develops when you do not have enough lactase in your body. This enzyme is essential to break down sugar lactose.

Alcohol: Drinking alcohol in moderation, or about one drink per day, usually does not cause stomach pain. But drinking too much alcohol simultaneously or for an extended period can cause the stomach’s lining to become inflamed. Long-term inflammation can cause bleeding.

Overeating: When you overeat, your stomach can expand beyond its standard size. This puts a lot of pressure on the organs that surround it. This pressure can cause pain in your bowel.

It can also make breathing difficult because your lungs have less space to expand when you inhale.

Overeating can also cause acid and stomach contents to return to your esophagus. This can cause heartburn and acid reflux. These conditions can worsen the epigastric pain you feel after eating.

If you have an eating disorder related to binge eating, repeated vomiting after eating can also cause epigastric pain.

A hiatal hernia occurs when a part of your stomach is pushed into your diaphragm through the hole through which the esophagus passes, which is called a hiatus.

Hiatal hernias do not always cause pain or discomfort.

Inflammation of the gallbladder or gallstones: epigastric pain may develop when the gallbladder becomes inflamed when gallstones block the gallbladder’s opening. The condition is known as cholecystitis. This can be painful and may require hospitalization or surgery.

Symptoms that may coexist with epigastric pain

Considering that the presentation of epigastric pain is the result of an underlying condition most of the time, additional symptoms may also occur. This could include:

  • Pain in the abdomen.
  • Frequent belching
  • Constipation with alternating diarrhea.
  • Abdominal distension.
  • Acidity.
  • Abdominal pain.
  • Indigestion.
  • Swelling in the abdomen
  • Abnormal acid taste in the mouth.
  • Frequent belching
  • Sore throat or hoarseness
  • Feel a lump in the throat.
  • Persistent cough
  • Burning sensation in the stomach or chest area.
  • Nausea and vomiting.
  • Gas problems

The pain may appear along with other symptoms of the underlying disorder or the original disease.

A severe heart condition can also mimic epigastric pain, so it is essential to seek emergency medical help if you think it is. Epigastric pain in this scenario can occur along with tightness in the chest, palpitations, and shortness of breath, with radiated pain in the left arm.

Some cases of epigastric pain may be symptoms of an imminent heart attack or other life-threatening dangers:

  • Pain in the chest, tightness, and pressure in the chest, including beatings.
  • Pain that moves through the shoulder and arm.
  • Breathing difficulty can also lead to suffocation.
  • Presence of blood or black components in the vomit.


In general, rare and isolated cases of epigastric pain do not lead to severe complications. However, if you suffer from chronic or prolonged epigastric pain that affects your quality of life in general, it can lead to several complications in the future.

If you find that your eating patterns have changed, resulting in involuntary weight loss, it is recommended to consult a doctor immediately. Complications of epigastric pain may include:

  • Cancer of the esophagus, stomach, or other organs.
  • Healing and esophageal narrowing.
  • Myocardial infarction (heart attack) if the pain is due to angina.
  • Poor nutrition due to a lower desire to eat.
  • Poor quality or poor lifestyle (diet, exercise, and well-being).

How to diagnose epigastric pain

Epigastric pain can be a vague symptom since there are many chances of it happening. Your doctor or health professional will have to ask you some questions about your epigastric pain and any additional signs to understand ​​its origin better.

If the diagnosis is uncertain, the doctor initially examines the patient’s history and performs a physical examination and some tests to diagnose the actual cause. These may include:

X-rays: allows a visual representation of the abdominal cavity showing the kidneys, bladder, and ureters.

Endoscopy: Using a camera at the end of a telescopic tube allows direct visualization inside the body to evaluate problems in the esophagus, such as inflammation or growth of the mass. Endoscopy also can take a tissue sample if necessary.

Urinalysis: to evaluate a urinary tract infection or other disorder related to epigastric pain.

Blood tests: complete blood count test to determine hemoglobin levels and blood count, looking for any abnormality of the organs that may indicate a more insidious underlying cause of epigastric pain.

Also, a blood test for evaluating liver and pancreatic enzymes and erythrocyte sedimentation rate to detect the speed of inflammation in the body.

Cardiac tests: to check if the heart is involved in pain, several tests, such as looking for cardiac biomarkers, a stress test, and an electroencephalogram to help identify if the heart is the cause of epigastric pain.

When to visit the doctor

Epigastric pain usually does not cause such risks and may disappear in one or two hours. But in severe cases, one should visit a doctor when the following symptoms are common:

  • Continuation of pain for more than one or two days.
  • The sensation of regular burning and discomfort after eating.
  • Pain in the chest and stomach.
  • Acid regurgitation at frequent intervals.

Occasional epigastric pain is usually not a concern, but anyone with severe or persistent epigastric pain should consult their doctor.

Symptoms that last more than a few days or regularly occur more than twice a week would be considered persistent.

It is recommended to seek the help of a medical professional if you experience severe and continuous epigastric pain that affects daily life. If you experience any following symptoms, go to the emergency room.

  • High fever.
  • Chest pain.
  • Difficult breathing
  • Faint.
  • Problems breathing or swallowing
  • Throwing blood
  • Blood in stools or black, tarry stools.

By consulting your doctor, you can identify any potentially harmful underlying conditions. If some of these conditions are not treated, they can cause new abnormalities or endanger life.

You should also see your doctor if your symptoms last more than a few days without improving with over-the-counter medications or at home. Many causes of epigastric pain can be easily treated, including chronic conditions.

Seeing your doctor as soon as you notice that epigastric pain does not go away can help relieve your symptoms and control any underlying conditions.

Many cases of epigastric pain can be treated and prevented by making small changes in diet or lifestyle. Even chronic symptoms can be managed well with medications and changes in diet.


The cause of your epigastric pain will determine the most effective form of therapy. Some cases of intermittent epigastric pain may not need treatment at all, and it is only recommended to avoid triggers.

The treatment for epigastric pain depends on the cause. If your pain results from your diet or overeating, your doctor may recommend that you change your diet or lifestyle.

This may include exercising for approximately 30 minutes each day or eating healthier foods. Eating foods such as ginger and taking vitamin B supplements can help relieve symptoms such as nausea and vomiting.

Suppose the pain results from taking certain medications, such as nonsteroidal anti-inflammatory drugs. In that case, your doctor may tell you to stop taking these medications and help you find another way to control pain.

Your doctor may recommend antacids or even acid-blocking medications to relieve your pain.

Suppose an underlying disease, such as gastroesophageal reflux disease, Barrett’s esophagus, or peptic ulcer disease, is causing your epigastric pain. In that case, you may need antibiotics and long-term treatment to control these conditions.

The treatment can last for months or even the duration of your life, depending on the cause. The treatment used for mild cases of persistent epigastric pain, not due to a severe underlying condition, may include the following:

Antacids: meditation to help reduce the overproduction of stomach acid. Several types of over-the-counter antacids can try to relieve your epigastric pain. Brands like Zantac and Pepcid, and their generic forms, Ranitidine and Famotidine, can help alleviate their symptoms.

Be sure to follow the instructions on when to take the medication and how much.

H2 Blockers: Commonly prescribed for the treatment of peptic ulcers, this form of medication prevents the formation of excessive stomach acid.

Nonsteroidal anti-inflammatory drugs (NSAIDs, for their acronym in English ): are used to help relieve pain and reduce inflammation.

Consider surgery: you can not decide on your own to undergo surgery for epigastric pain, but it is an option that you can discuss with your doctor. Surgery can be a good option if you try medications, home remedies, and lifestyle changes and still do not feel better.

There are many possible surgical procedures to treat epigastric pain. Your doctor can help you decide based on your weight, the severity of your pain, and any other health problems you have.

Home remedies

While it is recommended to see a doctor if you have persistent epigastric pain, mild intermittent pain can be remedied at home using the following methods:

Drink aloe vera juice before meals: the same soothing properties that make aloe vera a cure for sunburn can also help relieve epigastric pain, a standard treatment for stomach problems.

It is important not to dilute this juice in other liquids to obtain the full benefit. Drink ½ cup (8 ounces) of aloe vera juice before meals.

Aloe vera juice can act as a laxative, so when you look for it in the store, be sure to get one that indicates on the label that the laxative properties have been removed.

Ginger tea: considered an excellent treatment for the relief of stomach problems, ginger tea can help neutralize stomach acid and reduce inflamed or irritated tissue in the digestive tract.

Mix baking soda with water: for occasional epigastric pain, try to drink ½ to 1 teaspoon of baking soda in a glass of warm water; consuming this powder can help neutralize the acidic nature of your stomach. If the problem persists after a few days, try two teaspoons.

Avoid using the remedy too often because high salt content can cause swelling and nausea.

Chamomile tea: a common remedy for indigestion; chamomile tea helps fight the symptoms of epigastric pain by soothing the stomach. This tea is also used to relieve heartburn.

Yogurt: known to relieve indigestion and pain caused by digestive problems. It does this by increasing the number of beneficial bacteria in the digestive tract.

Burnt toast: used to help detoxify the stomach.

Peppermint tea: made from mint leaves, it can be an excellent remedy to relieve epigastric pain. However, mint is not recommended in cases of gastroesophageal reflux, as it can trigger acid reflux.

Try a piece of sugar-free gum after eating: your body naturally produces more saliva when chewing gum. Extra saliva can help eliminate the excess acid that creates epigastric pain. Chew a piece of sugar-free gum for 30 minutes after eating.

Drink a cup of warm water with lemon: if you drink warm lemon water 15 to 20 minutes before eating in the morning, it can help balance the stomach’s pH levels. Drink it slowly, and let me help you wake up too!

Fortunately, most acute cases of epigastric pain are not severe and require only minor intervention for relief. However, chronic epigastric pain can be a sign of imminent serious complications.

Fortunately, most acute cases of epigastric pain are not severe and require only minor intervention for relief. However, chronic epigastric pain can be a sign of imminent serious complications.

Knowing this, it is essential to recognize the signs of normal and abnormal epigastric pain and to consult a doctor as soon as possible when something undoubtedly feels terrible.