The epigastrium is one of the quadrants of the abdomen. It is the region lying between the subcostal plane and the costal margins. To understand this, it is the region that is located in the middle of the upper part of the abdomen.
Pain can occur in this region. This localized pain is due a number of causes. Epigastric region comprises mainly stomach, pancreas, duodenum and a part of liver in addition to muscles, peritoneum and fascia. Pain arises in this area due to problems related to these organs. Pain can be radiated to this region from some other disease area.
The pain of epigastric area has many characteristics. It can occur during eating or after a meal. It can occur at any time or at some particular times. It can be dull and moderate to severe in nature.
Epigastric Pain Location
Picture 1- Location of Epigastric Pain
Causes of Epigastric Pain
There are many causes of the epigastric pain. Many disorders and diseases can lead to the uncomfortable feeling in this area. Therefore, it becomes difficult to diagnose the exact condition causing this pain. Here, we have presented all the possible aetiologies behind this pain.
Gastrointestinal reflux disease
Gastroesophageal reflux disease (GERD) is a condition in which a person feels burning sensations behind the sternum. This sensation can be felt in the epigastric region. This condition arises due to regurgitation of food from the stomach back to the oesophagus.
It is also associated with nausea and a feeling of stickiness of food behind the chest. It is basically a disease due to defect in the oesophagus. The pain of GERD gets worse on lying down, bending or stopping.
It is a condition characterized by burning sensations as a result of high gastric acid secretions. This acid is secreted from the stomach and reflexes back to the oesophagus. It is also known as cardialgia or pyrosis. It causes pain behind the sternum as well as in the epigastrium.
Diseases of the Stomach
There are many diseases of the stomach that lead to pain in the epigastrium. The most common is the peptic ulcer disease. Here pain arises due to inflammatory conditions, infections or malignancy.
Gastritis is the condition in which pain occurs in the epigastric region. It is an inflammatory condition of lining of the stomach. Not only pain occurs but nausea and weight loss also occur here.
Peptic and Duodenal Ulcer
These are the most common causes of the epigastric pain. Here ulcer formation takes place due to infection by Helicobacter pylori bacteria. In case of peptic ulcer, epigastric pain gets settled on eating a meal.
In addition to epigastric pain, there are symptoms of waterbrash, bloating, hematemesis and abdominal fullness. Duodenal ulcer gets aggravated after taking a food and pain appears two to three hours after the meal.
Malignancy of the stomach is also associated with pain in the upper central area of the abdomen. It is characterized by not only pain but also weight loss, abdominal pain and different other manifestations.
It is the inflammatory disease involving the stomach and the intestine. The main symptoms are abdominal pain, fever, nausea and diarrhoea.Disorders of Pancreas
Pancreatitis is the major cause of pain in the epigastric region. This inflammation of pancreas can be acute or chronic. Acute pancreatic occurs with a severe pain that radiates towards back. Chronic is characterized by mild pain in the epigastrium.
It is one of the causes of severe pain in the area of epigastrium.
Disorders of Gallbladder Causing Pain
Gallbladder stones or gallbladder’s inflammation usually produce pain in the right abdominal region that also radiates to the epigastric area. The pain is usually gnawing.
Hepatitis is the condition in which pain may also be felt in the epigastric area. This liver inflammation is most commonly the result of infection by the virus. Hepatitis is characterized by yellow discoloration of the skin and sclera, weakness and fever.
Miscellaneous Other Conditions Causing Epigastric Pain
There are various other disorders that may lead to pain in the epigastrium such as:
- Chronic cough
- Hital hernia
- Abdominal muscle strain
- Perforated Ulcer
- Abdominal aortic aneurysm
Diagnostic Tests For Epigastric Pain
After taking patient’s history and performing general physical examination, the doctor will ask you to undergo following important tests to detect the real cause of the pain in the epigastric area.
Complete Blood Count
It is an essential and basic test that helps to determine different things such as haemoglobin level and count of blood cells.
This test is done to evaluate the levels of enzyme particularly pancreatic and liver enzymes. In case of some abnormalities of pancreas and liver, these enzymes are usually elevated.
Erythrocyte Sedimentation Rate (ESR)
It determines the presence of inflammation in the body.
Abdominal X-ray is done to check out the presence of obstruction or a mass.
This is usually performed to assess possible problems related to the oesophagus and the stomach. It detects the presence of any abnormal mass, inflammation or any other abnormality. Endoscopy is recommended when the cause is not evident by usual tests.
Other tests may also be ordered such as urinalysis, ultrasound examination or CT scan depending on the symptoms with which patient is presented.
Treatment of Epigastric Pain
Treatment is given depending on the diagnosis of the pain in the epigastric region. Sometimes, pain occurs instantly and also settles within a few hours. Such pain does not require treatment as such. But pains associated with different other symptoms requires definite treatment.
Following are the commonly prescribed drugs for the conditions causing pain in the epigastric area:
- Non Steroidal Anti-inflammatory Drug: These are quite helpful in providing relief from the pain as well as in resolving inflammation and fever too. Ibuprofen is particularly found helpful here in treating pain.
- H2 Receptors Blockers: These are usually prescribed for the treatment of peptic ulcers and heartburn. These drugs prevent the formation of excessive gastric acid by the stomach, thus prevent ulcer formation as well as burning feelings behind the breastbone.
- Antacids: It’s a substance that neutralizes stomach acidity. The salts containing aluminium and magnesium are usually given to treat peptic ulcer.
Usually mild form of epigastric pain is not life threatening and it goes away on its own. However, severe pain with different symptoms requires immediate medical intervention. It is best to consult your health care provider if you feel constant pain in the epigastric region i.e. in the upper middle portion of the abdomen.