Epigastric pain

Epigastric pain is pain or discomfort felt in the middle of your upper abdomen, in the area between your ribs and your belly button. Your stomach, pancreas, small intestine and parts of your liver sit in this area.

The sensation itself may be described as burning, aching, gnawing or cramping, and may be constant or come and go.

What causes epigastric pain?

Most epigastric pain is linked to digestion. Common causes include:

• indigestion, often after overeating or eating too quickly
• acid reflux or gastro-oesophageal reflux disease (GORD)
• gastritis, which is inflammation of your stomach lining – often linked to infection, alcohol or anti-inflammatory painkillers
• a stomach or duodenal ulcer
• gallstones or an inflamed gallbladder
• an inflamed pancreas (pancreatitis)
• a hiatus hernia, where part of your stomach pushes up through your diaphragm.

Less often, epigastric pain has a cause outside your digestive system. A heart problem, such as angina or a heart attack, can cause pain felt in your abdomen instead of, or alongside, your chest.

Rarely, it can be a sign of stomach on pancreatic cancer, particularly in people over 50 with unexplained weight loss or bleeding.

Are there different types of epigastric pain?

The pattern of your pain can offer a clue to the cause:

• Postprandial pain: This is pain that’s worse after eating, and can point towards gastritis, ulcers or gallbladder problems
• Nocturnal pain: This is pain that’s worse at night and may even wake you in the night, which can also point towards an ulcer.

How is epigastric pain diagnosed?

Your doctor will ask about your symptoms, including whether the pain is worse after eating or at night, what triggers it, how often it happens, and whether anything eases it. They'll examine your abdomen, and may listen to your bowel sounds with a stethoscope.

Depending on what they suspect, you may also be offered the following:

• Blood tests: These are to check for infection, inflammation, or problems with your liver, pancreas or gallbladder
• A stool or breath test: This is to check for a Helicobacter pylori (H pylori) infection
• An upper endoscopy: This is where a thin, flexible camera is passed down your throat to look at your oesophagus and stomach lining, sometimes taking a small tissue sample (biopsy)
• An ultrasound scan: This is to check your gallbladder, liver and pancreas
• An ECG (heart tracing): This is if a heart-related cause is suspected

How is epigastric pain treated?

Treatment depends entirely on what's causing your pain. Your doctor might prescribe one of the below:

• A proton pump inhibitor (PPI): This is the most commonly used medicine, which reduces the amount of acid your stomach makes
• An H2 blocker or antacid: These are sometimes used to ease heartburn and acid reflux
• Antibiotics: These are only needed if an H pylori infection is found
• Surgery: This is for gallstones or, occasionally, a hiatus hernia

For mild pain linked to digestion, these changes can also help:

• eat smaller, more frequent meals rather than large ones
• avoid foods that trigger your symptoms, such as fatty, spicy, acidic or fried food, and alcohol or caffeine
• avoid smoking
• drink plenty of fluids
• manage stress, for example through exercise, yoga or meditation
• stay upright for 30 minutes after eating

hold a warm compress or hot water bottle against your stomach for 15 to 20 minutes to relax the area and ease discomfort.

When should I see a doctor?

Occasional mild epigastric pain, such as after a big meal, is common and usually settles on its own.

See your GP if:

• the pain has lasted more than a few days without improving
• it keeps coming back
• it's affecting your eating, sleep or daily life
• you have unexplained weight loss or loss of appetite
• you have difficulty swallowing
• you're over 50 and notice blood in your stool or vomit, or you're losing weight without trying.

Call 999 or go to A&E if you have epigastric pain along with:

• chest tightness or pain spreading to your jaw or left arm
• sudden, severe pain that doesn't ease, especially if it spreads through to your back
• vomiting blood, or passing black, tarry stools
• breathlessness, sweating, dizziness or a fast heartbeat
• yellowing of your skin or eyes (jaundice) with a fever
• collapse.