Epigastric pain is a common symptom that can occur in people of all ages. It can be a warning sign of various underlying conditions—some mild and easily treatable, while others may be severe and potentially life-threatening.

What are the causes and symptoms of epigastric pain?

 

1. Gastritis, peptic ulcer, and duodenal ulcer These are common causes. Patients experience intermittent epigastric pain or pressure, abdominal tightness, and nausea/vomiting—often when hungry or shortly after meals.
2. Gastroesophageal reflux disease (GERD) Patients feel pressure from the epigastrium to the mid-chest, burning chest pain, sour belching, a bitter or sour taste in the throat, and indigestion.
3. Gallstones and cholecystitis Patients have cramping pain under the right rib cage and in the epigastrium that comes in waves, often after fatty meals. The pain is severe and persistent even after taking medication. More common in middle-aged women with excess weight than in men.
4. Pancreatitis Patients have severe epigastric pain radiating to the back, with nausea and vomiting, and pain usually does not improve with medication. Often seen in frequent alcohol users or those with very high triglycerides.
5. Liver disease Patients feel tightness under the right rib cage and in the epigastrium, with bloating, poor appetite, weight loss, jaundice, and yellow eyes.
6. Gastric and esophageal cancer Patients have chronic epigastric tightness/pain, dysphagia, vomiting, loss of appetite, and weight loss.
7. Pancreatic and bile duct cancer Patients have chronic epigastric pain radiating to the back, bloating, indigestion, poor appetite, weight loss, jaundice, itching, dark urine, and pale stools.
8. Coronary artery disease / cardiac ischemia Patients develop chest tightness in the mid-chest, epigastrium, or left chest; pain may radiate to the shoulder blade, shoulder, neck, or left jaw, with sweating, palpitations, and near-fainting—often triggered by exertion. Rest may improve symptoms.

 

When should you get an upper GI endoscopy?

 

• Chronic abdominal pain lasting more than 4 weeks
• Pain that does not improve despite medication
• Difficulty swallowing or food sticking
• Vomiting blood
• Black stools or blood in stools
• Loss of appetite or unexplained weight loss
• Anemia
• Age over 50 without prior diagnostic endoscopy, or over 40 with a family history of stomach cancer

 

 

If you have unexplained abdominal pain, consult the Abdominal Pain Center, Division of Gastroenterology, Hepatology, and Biliary Tract at Synphaet Ramintra Hospital.

Because abdominal pain may be a warning sign your body is sending—don’t ignore it.

 

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