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Epigastric Pain

What is Epigastric Pain?

The epigastrium is the central part of the abdomen, being divided in the upper side by the sternum and below by the umbilicus. There are a lot of people who experience epigastric pain, which can be an indication of a poor diet or it can be suggestive of a more serious underlying disorder. In the paragraphs below, you will find information on the signs and symptoms of epigastric pain, as well as the causes and the making of the diagnosis. You will also be presented with information on how the epigastric pain is treated and why the epigastric pain appears after eating or in women who are pregnant.


Signs and Symptoms

These are the most common signs and symptoms that accompany the epigastric pain:

  • Heartburn
  • Nausea
  • Vomiting
  • Bloating
  • Flatulence
  • Constipation
  • Diarrhea
  • Swelling of the abdomen
  • Belching

If you are experiencing the following symptoms, besides the epigastric pain, you might be having a heart attack. What you need to do is call 911 and request emergency medical intervention.

  • Tightness in the chest
  • Heart palpitations
  • Sensation of a huge weight being on the chest
  • Left arm or shoulder numbness
  • Difficult breathing – choking sensation.

Where is Epigastric pain located?

epigastric pain

Picture : Epigastric pain location

The epigastric pain is located in the central part of the abdomen, just below the ribs. Sometimes, because of its location, it can be mistaken with the pain that is caused by angina or heart attack.

What are the Causes of Epigastric pain?

These are the most common causes that lead to the appearance of the epigastric pain:

GERD (gastroesophageal reflux disease)

  • The acid from the stomach refluxes into the esophagus, leading to heartburn and epigastric pain
  • One can also experience nausea and vomiting
  • The symptoms are aggravated when the patient is lying down, especially after a meal

Gastric ulcer

The ulceration that appears inside the stomach, on the mucosa lining, can lead to epigastric pain among other symptoms

Duodenal ulcer

  • The ulceration appears in the smaller intestine, leading to epigastric pain
  • Most often caused by the infection with helicobacter pylori
  • The pain appears a couple of hours after the patient has finished eating, as opposed to the gastric ulcer, where the pain appears during the meal (in the duodenal ulcer, eating actually calms the pain)
  • One can also experience bloating and flatulence

Stomach infection

  • This can appear as a person eats foods that contain infectious microorganisms, such as salmonella
  • Apart from epigastric pain, one can feel nauseous and vomit
  • High-running fever and general state of weakness can appear in more serious infections

Gastritis

  • The interior mucosa of the stomach becomes inflamed, with pain occurring in the epigastric region
  • Due to the constant irritation, the patient might avoid eating altogether, which ultimately leads to weight loss

Gastric cancer

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  • Epigastric pain is one of the signs of gastric cancer
  • Apart from that, the patient might experience pain in the other parts of the abdomen and pronounced weight loss

Pancreatitis

  • The inflammation of the pancreas (acute or chronic) often leads to epigastric pain
  • In acute pancreatitis, the pain can radiate to other parts of the body, such as the back
  • The mild pain in the epigastrium is significant of chronic pancreatitis

Pancreatic cancer

  • Characterized by severe pain in the epigastrium

Gallbladder disorders – gallbladder stones or inflammation

The pain from the gallbladder stones or the inflamed gallbladder can radiate to the epigastrium, being quite intense

Hepatitis

  • Epigastric pain can be one of the symptoms of hepatitis
  • Look for the other signs of hepatitis – yellowish tinge of the skin, weight loss, fever

Other conditions

  • Tuberculosis – due to the chronic cough
  • Hiatal hernia
  • Straining of the abdominal muscles
  • Perforated ulcer – represents a medical emergency, immediate intervention is required before the symptoms become life threatening
  • Aneurysm of the abdominal aorta

Diagnosis

These are the most common measures used for the diagnosis of epigastric pain:

  • Patient assessment
    • Medical history
    • Physical examination – palpation of the abdomen
  • CBC (complete blood count)
    • Hemoglobin levels
    • White blood count – identify whether there is an infection in the body or not
  • Blood test
    • Liver enzymes – indicate functioning of the liver
    • Pancreatic enzymes – indicate functioning of the pancreas
  • Erythrocyte sedimentation rate/ C-reactive protein
    • Both are markers that demonstrate inflammation in the body (elevated levels)
  • X-ray
    • Abdominal X-ray – identification of mass in the abdomen
  • Endoscopy
    • Diagnosis test for gastric or duodenal ulcer
    • Can be useful to identify the presence of a mass in the esophagus or stomach
    • Can also be recommended in patients who present symptoms of gastritis or when the cause of the epigastric pain cannot be identified through other methods
  • Urine analysis
    • High white blood cell count – infection in the body
  • CT or MRI scan
    • Better visualization of the abdomen – identification of mass inside the abdomen.

Treatment

These are the most common measures of treatment that can be taken for epigastric pain:

Anti-inflammatory medication

  • The administration of oral anti-inflammatory medication can bring the necessary pain relief and also reduce the inflammation commonly associated with the pain
  • Most commonly recommended – acetaminophen, ibuprofen
  • Also indicated in patients who present systemic symptoms, such as high-running fever

H2 receptor blockers

  • Recommended as treatment for ulcer and also for those who are suffering from GERD
  • They work by inhibiting the excess production of acid in the stomach, thus improving the symptoms experienced by the patient

Antacid medication

  • The medication can be administered as pills or as a drinkable solution, working to neutralize the excessive acidity of the stomach
  • Often recommended to those who are either suffering from gastritis or different types of ulcer.

Epigastric pain after eating

If you are experiencing epigastric pain after eating, you might be suffering from a peptic or duodenal ulcer. This means that somewhere down the small intestine there is an ulceration causing you all of these problems. Patients suffering from peptic ulcer often find that eating actually calms their pain; however, at several hours after the meal, as the digestion is in progress, the pain will re-appear. Specific medication and a change in the dietary habits can improve the symptoms experienced.

Epigastric pain in pregnancy

The epigastric pain that occurs in pregnancy can be explained by the growing uterus that presses down on all the structures that are in the area, including the stomach and the small intestines. Apart from that, the mom-to-be is going through a lot of hormonal changes, which can interfere with the digestion process and cause the appearance of the epigastric pain.

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