Quick answer: Stomach and back pain occurring simultaneously most commonly indicates pancreatitis, a penetrating gastric or duodenal ulcer, or a biliary tract disorder. This type of upper abdominal pain radiating to the back always requires examination by a specialist to ensure an accurate diagnosis.
Many people experience pain in the stomach area from time to time, and back pain is often treated as a separate issue. However, when stomach and back pain occur at the same time, they can often be traced back to a single common cause. This is because pain from the epigastric organs can typically radiate towards the back.
In this article, we explain in simple terms which common gastroenterological conditions can cause this set of symptoms, when it is worth taking the symptoms more seriously, and which tests can help in reaching an accurate diagnosis. Our aim is to reduce uncertainty and to show that diagnostic investigations can now be carried out comfortably and without fear.
Why does stomach pain radiate into the back?
Due to the nerve connections of the abdominal organs – the stomach, duodenum, pancreas and bile ducts – pain originating in this area is often felt not only at the front but also radiating towards the back. In medical terms, this is known as pain radiating to the back.
The direction and nature of the pain radiating to the back can reveal a great deal about its source. For example, a constant, piercing pain radiating to the back is often linked to the pancreas, whilst a throbbing, cramp-like pain is more likely to indicate a biliary tract origin.
What conditions can cause both stomach ache and back pain at the same time?
Abdominal pain that radiates to the back can be caused by a number of gastroenterological conditions. The most common causes are summarised below.
Inflammation of the pancreas (pancreatitis)
Pancreatitis is one of the most common causes of simultaneous stomach and back pain. The pain starts in the upper abdomen; it is deep and piercing in nature, and often radiates to the middle or lower back. Many patients find that the pain worsens when lying on their back, but is relieved when sitting with their upper body leaning forwards.
In the acute form, the pain may be accompanied by nausea, vomiting and a mild fever. In the vast majority of cases, the condition is caused by gallstones or alcohol consumption. In chronic pancreatitis, the pain is usually exacerbated by eating and may be accompanied by fatty stools and weight loss.
Stomach and duodenal ulcers
Peptic ulcers typically cause pain around the pylorus. Symptoms of a duodenal ulcer often occur before meals or at night, and may be temporarily relieved by eating. In the case of a gastric ulcer, however, eating often makes the symptoms worse.
It is an important warning sign if the pain from an ulcer radiates into the back or becomes constant. This may indicate a so-called ‘penetrating ulcer’, which extends towards the pancreas. The bacterium Helicobacter pylori and the long-term use of painkillers (NSAIDs) play a key role in the development of ulcers.
Gallstones and cholecystitis
Biliary colic caused by gallstones begins in the region of the epigastrium or beneath the right costal margin, and often radiates towards the back, the right shoulder blade or the area between the two shoulder blades. The pain gradually intensifies and may be accompanied by nausea, sweating and, in some cases, jaundice.
In cases of cholecystitis, the pain is severe, constant and typically lasts for more than four to six hours. The risk of gallstones is increased by older age, being female, being overweight and a high-fat diet.
Reflux and oesophagitis
The most characteristic symptom of gastro-oesophageal reflux disease (GERD) is heartburn, that is, a burning sensation behind the breastbone. However, the discomfort may also radiate to the back, the jaw, and the left shoulder and arm. The symptoms may be triggered by bending forward, lying down or eating certain foods (spicy, fatty or acidic dishes).
When do stomach and back pain indicate a serious problem?
If certain accompanying symptoms are present, medical investigation cannot be delayed. These are known as warning (alarm) symptoms. Please consult a specialist as soon as possible if, in addition to stomach pain radiating to the back, you notice any of the following:
- Unexplained, significant weight loss
- Difficulty swallowing or painful swallowing
- Black (tar-like) or bloody stools
- Vomiting that looks like blood or coffee grounds
- Iron deficiency anaemia
- Jaundice (yellowing of the skin or the whites of the eyes)
- Persistent vomiting, high fever
- Sudden, extremely severe abdominal pain
These symptoms may also indicate a more serious condition, such as ulcer bleeding, inflammation or a tumour, and therefore require prompt medical assessment.
What tests can help with the diagnosis?
In order to make an accurate diagnosis, the gastroenterologist selects the appropriate tests based on the patient’s symptoms and medical history. The most commonly used methods are as follows.
Gastroscopy
Gastroscopy plays a key role in the investigation of abdominal pain radiating to the back. During the procedure, the specialist directly examines the mucous membranes of the oesophagus, stomach and duodenum, enabling them to accurately identify ulcers, inflammation or other abnormalities. It is also possible to take tissue samples and carry out Helicobacter pylori testing during the examination.
Colonoscopy
If the symptoms are thought to be caused by a disorder of the lower gastrointestinal tract – such as iron-deficiency anaemia, bowel dysfunction or occult bleeding – the specialist may also recommend a colonoscopy to examine the entire large intestine.
Imaging and laboratory tests
An abdominal ultrasound is primarily used to assess biliary tract diseases and the condition of the pancreas. CT and MRI scans provide more detailed imaging. Among laboratory tests, elevated amylase and lipase levels may indicate pancreatitis, whilst abnormalities in the blood count and iron levels may suggest possible bleeding.
How is Endomedix connected to this?
At Endomedix’s gastroenterology centres, experienced specialists investigate stomach pain that radiates to the back. The diagnostic process begins with a thorough assessment of the symptoms and a gastroenterology consultation, which is the first step towards an accurate diagnosis and a treatment plan.
Many patients are afraid of endoscopic procedures, even though the examination can now be carried out comfortably. At Endomedix, for professional reasons, gastroscopy and colonoscopy are carried out under anaesthesia (using propofol sedation), so the patient sleeps through the entire procedure and feels no pain or discomfort. The anaesthesia is supervised by a qualified anaesthetist, who monitors the patient’s vital signs throughout the entire examination.
The choice of test always depends on the nature of the symptoms:
- In the case of abdominal pain radiating to the back, the first step is GASTROSCOPY UNDER ANAESTHESIA recommended.
- If an abnormality in the lower alimentary tract is also detected, COLONOSCOPY UNDER ANAESTHESIA may also be justified.
- For a comprehensive overview of the entire digestive system, the GASTRIC AND COLONOSCOPY UNDER ANAESTHESIA offers a comprehensive solution in a single anaesthetic session.
- If you’re still unsure which test you need, start with a with a consultation with a specialist in gastroenterology, where our specialists provide personalised advice.
Don’t put off getting checked out
The simultaneous occurrence of stomach ache and back pain often indicates a gastroenterological condition that can be effectively managed with appropriate treatment. An accurate diagnosis is the basis for effective recovery, and early detection helps to prevent more serious complications.
If you are experiencing persistent stomach pain that radiates to your back, do not delay getting it checked out. Book an appointment at one of Endomedix’s gastroenterology centres, where our specialists will help you identify the cause of your symptoms using comfortable, sedated examinations.
Frequently asked questions
What does it mean if stomach pain radiates into the back?
Stomach pain radiating to the back most commonly indicates a condition affecting the pancreas, a penetrating ulcer in the back, or a disease of the bile ducts. Constant, stabbing pain that radiates to the back always requires examination by a specialist.
Could pancreatitis be the cause of stomach and back pain?
Yes. Pancreatitis is one of the most common causes of these two symptoms occurring together. The pain typically starts in the upper abdomen and radiates towards the back; it intensifies when lying on one’s back and eases when leaning forwards.
Does a gastroscopy hurt?
At Endomedix, gastroscopy is carried out under sedation (using propofol), so the patient is asleep during the procedure and feels no pain. The sedation is supervised by a specialist anaesthetist to ensure complete safety.
When should you seek immediate medical attention for stomach ache and back pain?
Immediate medical attention is required if the symptoms are accompanied by unexplained weight loss, black or bloody stools, coffee-ground-like vomit, jaundice, persistent vomiting, a high fever or sudden, extremely severe abdominal pain.
Which examination do I need: a gastroscopy or a colonoscopy?
The choice depends on the nature of the symptoms. In cases of epigastric pain radiating to the back, an upper gastrointestinal endoscopy is generally recommended, whilst a colonoscopy is advised for symptoms affecting the lower gastrointestinal tract. If there is any uncertainty, it is advisable to start with a consultation with a gastroenterologist.
