Quick answer: The most common causes of epigastric pain are gastro-oesophageal reflux disease (GERD), gastritis, peptic ulcers and functional dyspepsia. To determine the exact cause, a gastroenterological examination is required, most commonly involving an endoscopy. Choose the experts at Endomedix, who will support your recovery with professional care and pain-free examinations.
Pain in the epigastrium is an extremely common complaint that occurs in the middle of the upper abdomen, just below the ribs. Many people experience a burning, gnawing or even dull, pressing pain in this area at some point in their lives. Although in some cases the problem is simply caused by a heavy meal or temporary stress, regularly recurring symptoms may also indicate more serious gastroenterological conditions. Among women, particularly around the age of fifty, both hormonal changes and lifestyle factors can exacerbate these symptoms.
Without proper medical guidance, patients often feel uncertain and worry about the possible causes. The vast amount of information available online, which is sometimes contradictory, can only serve to increase their anxiety. That is precisely why it is essential to take symptoms seriously and seek expert medical help. An accurate diagnosis not only brings peace of mind but also forms the basis for targeted and effective treatment.
In this article, we examine in detail the anatomical and physiological processes that may lead to the development of these symptoms. We outline the most common accompanying symptoms and review the modern diagnostic methods that can be used to reliably identify these conditions. We will also discuss how Endomedix’s experienced gastroenterology specialists can help you on your path to recovery.
What can cause pain at the pit of the stomach?
Gastroenterology, the branch of medicine dealing with disorders of the digestive system, has identified a number of conditions that can cause abdominal discomfort. Accurate differentiation between these conditions requires clinical precision, as their symptoms often overlap.
Gastro-oesophageal reflux disease (GERD)
The reflux of stomach acid into the oesophagus is one of the most common causes. In such cases, the sphincter muscle around the lower end of the oesophagus does not function properly, allowing acidic stomach contents to rise up. This condition causes irritation and inflammation of the oesophageal lining. It typically presents as a burning sensation in the chest, which worsens after meals or when lying down. In the long term, untreated reflux can lead to difficulty swallowing and even permanent damage to the mucous membrane.
Gastritis
Inflammation of the stomach lining is known as gastritis. A number of factors can play a role in its development, including infection with the Helicobacter pylori bacterium, excessive use of certain painkillers (NSAIDs), or heavy alcohol consumption. In its acute form, it causes sudden, severe pain, whilst in chronic cases, a dull, persistent feeling of discomfort is characteristic. Endoscopic examination and a biopsy help to confirm the inflammatory process.
Peptic ulcers (Ulcus pepticum)
Ulcers, or breaks in the lining, that form on the inner surface of the stomach or duodenum are known as peptic ulcers. When stomach acid comes into direct contact with these ulcers, an extremely sharp, burning pain in the epigastric region occurs. An interesting distinction is that whilst pain caused by a gastric ulcer often intensifies during or immediately after a meal, symptoms of a duodenal ulcer occur on an empty stomach and are temporarily relieved by eating.
Functional dyspepsia
It is often the case that even detailed medical examinations fail to reveal any organic abnormalities, yet the patient still suffers from severe abdominal symptoms. This condition is known as functional dyspepsia. Its symptoms include an early feeling of fullness, bloating and epigastric (around the pit of the stomach) pain. Although no organic cause can be identified, the symptoms are very real and significantly impair the patient’s quality of life. Treatment focuses on improving gastrointestinal motility (movement) and reducing visceral hypersensitivity.
Gallstones and pancreatic problems
Although they are anatomically situated in slightly different locations, disorders of the gallbladder and pancreas often cause pain that radiates to the epigastric region. The movement of gallstones can cause biliary colic, which is characterised by severe pain beneath the right rib cage that also radiates towards the centre. Pancreatitis, on the other hand, causes extremely severe upper abdominal pain that radiates around the waist into the back, requiring immediate medical attention.
What accompanying symptoms should you pay particular attention to?
Pain rarely occurs on its own. Observing accompanying symptoms provides key information for the treating doctor when making an accurate diagnosis. At Endomedix’s gastroenterology centres, specialists ask patients detailed questions about these symptoms.
The most common accompanying symptoms are as follows:
- Nausea and vomiting: Their regular occurrence may indicate inflammation or a blockage.
- Bloating and feeling full too soon: Even after eating just a small amount of food, I feel a tightness in my stomach.
- Difficulty swallowing (dysphagia): The sensation of food getting stuck in the oesophagus is a serious warning sign.
- Acid reflux: The reflux of stomach contents leaves a sour, burning taste in the mouth.
- Loss of appetite and unexplained weight loss: These symptoms always warrant a thorough and immediate medical examination.
When is it essential to see a doctor if you have pain in the pit of your stomach?
Many patients tend to put off seeing a doctor, hoping that their symptoms will go away on their own. However, there are certain „alarm” symptoms which, if noticed, require you to see a specialist immediately. Select the a specialist gastroenterology consultation, if the pain is persistent and does not respond to over-the-counter antacids.
Particularly dangerous signs include black, tarry stools (melaena) or vomiting blood, which indicate upper gastrointestinal bleeding. Urgent medical attention is also required if the pain suddenly becomes unbearable and radiates to the jaw, into the left arm or back, as these symptoms may indicate not only digestive problems but also cardiovascular issues (such as a heart attack). Unexplained weight loss, persistent difficulty swallowing and anaemia are also warning signs where an accurate diagnosis as soon as possible can literally be a matter of life and death.
How is diagnosis carried out at Endomedix centres?
Effective treatment is based on a precise, comprehensive diagnosis. The specialists at Endomedix have a wealth of experience and expertise in the diagnosis and treatment of a wide variety of digestive disorders. The examination process always begins with a thorough, personalised consultation.
The first step: A consultation with a gastroenterologist
During the consultation, the doctor will ask the patient in detail about their symptoms, when they began, their severity and any accompanying symptoms. They will review previous medical records, family medical history and any medication currently being taken. During the physical examination, the specialist will palpate the abdomen to locate any tender areas. They will then recommend the necessary diagnostic tests. Don’t wait any longer if you have any symptoms – book an appointment for a specialist gastroenterology consultation today.
The importance of endoscopic examinations
Gastroscopy is the most reliable diagnostic method for lesions of the upper gastrointestinal tract. During the examination, the doctor uses a thin, flexible instrument (an endoscope) to examine the mucous membranes of the oesophagus, stomach and duodenum from the inside. It is also possible to take a tissue sample (biopsy), which can be used to confirm, for example, a Helicobacter pylori infection or inflammation at the cellular level. If you are experiencing pain in the pit of your stomach, the GASTROSCOPY UNDER ANAESTHESIA provides the most accurate answer to the problem.
In certain cases, particularly if the symptoms also suggest gastrointestinal involvement (for example, anaemia or changes in bowel habits), the specialist may also recommend a colonoscopy. The COLONOSCOPY UNDER ANAESTHESIA During the procedure, the entire large intestine is examined to rule out polyps or cancerous lesions. If both examinations are indicated, the following is available for the patients’ comfort: GASTRIC AND COLONOSCOPY UNDER ANAESTHESIA as well, which takes place at the same time, under a single anaesthetic.
Why should we choose anaesthesia rather than sedation?
Many patients dread endoscopic procedures because of the pain and discomfort they expect to experience. It is important to clarify a fundamental professional principle: when it comes to sedation, at Endomedix we administer general anaesthesia exclusively for professional reasons; we do not use light sedation. General anaesthesia (deep sedation with propofol) guarantees complete freedom from pain and ensures the patient remains unconscious and calm. In contrast, during conventional sedation, the patient’s reflexes may remain active, and they may feel pain and discomfort, which can make precise medical work more difficult. General anaesthesia is always supervised by an experienced anaesthetist, ensuring maximum patient safety. At the end of the procedure, the patient wakes up feeling clear-headed and refreshed, with no unpleasant memories.
What treatment options are available?
Treatment for epigastric pain always depends on the underlying cause. There is no single universal cure; treatment must be tailored to the individual, based on an accurate diagnosis.
Lifestyle and dietary changes
In a significant proportion of cases, simply changing one’s eating habits can lead to a dramatic improvement. It is recommended to eat frequently in small portions and to avoid overly spicy or fatty foods, as well as excessive consumption of coffee and alcohol. Giving up smoking is also crucial, as nicotine weakens the sphincter muscle at the entrance to the stomach and increases acid production. If you experience symptoms at night, raising the head of your bed and avoiding eating for 2–3 hours before going to sleep may help.
Drug therapies
If the symptoms are caused by hyperacidity (for example, in cases of reflux or peptic ulcer disease), the treating doctor will most often prescribe proton pump inhibitors (PPIs). These medicines effectively reduce the production of stomach acid, allowing the mucous membrane to regenerate. If an infection with Helicobacter pylori is confirmed, a specific course of antibiotics (eradication therapy) is required to eliminate the bacterium. In cases of functional dyspepsia, prokinetics, which regulate bowel motility, and, in rarer cases, low-dose neuromodulators may provide relief.
Endoscopic and surgical procedures
If conservative treatments (lifestyle changes and medication) do not produce results, or if there is an anatomical abnormality (such as a large diaphragmatic hernia), surgery may be an option. Although these are less common, thanks to modern minimally invasive techniques, they can now be performed safely and with a quick recovery.
Frequently asked questions about pain in the pit of the stomach
What foods should I avoid if I often have a sore stomach?
Symptoms are most commonly triggered by foods that are too fatty, spicy or hot, as well as citrus fruits, tomatoes, chocolate, coffee, fizzy drinks and alcohol. It is worth keeping a food diary, as this makes it easy to identify your personal triggers.
Is a gastroscopy painful?
Gastroscopy under general anaesthesia at Endomedix is completely painless. For medical reasons, we only use general anaesthesia; we do not use sedation. This means that the patient is in a deep sleep during the procedure and does not experience any discomfort.
How long does it take for antacid medicines to work?
Modern proton pump inhibitor medicines usually bring significant relief within the first few days, but complete healing of the mucous membrane often requires continuous treatment for weeks or even months, as prescribed by a doctor.
Could stress be the sole cause of pain in the pit of the stomach?
Chronic stress alone can cause functional gastrointestinal symptoms, such as pain in the epigastric region, and it also increases gastric acid production. It is important to emphasise, however, that symptoms attributed to stress are often caused by underlying organic conditions, so a medical examination is definitely warranted.
What are the risks associated with untreated epigastric pain?
Persistent, untreated acid reflux causes long-term damage to the lining of the oesophagus and can lead to ulcers, scarring, narrowing, or even a precancerous condition (Barrett’s oesophagus). An untreated stomach ulcer can lead to bleeding or a perforation of the stomach wall.
Summary and next steps towards recovery
Pain in the pit of the stomach is a warning sign from the body that should not be ignored. Although the symptoms can be alarming, the causes can be identified quickly and gently using the tools of modern medicine. It is important to understand that, rather than self-diagnosis or relying on online remedies, professional gastroenterological care is the safest route to recovery.
Endomedix welcomes its patients with a high level of professional expertise, empathy and the very latest pain-free (anaesthetised) procedures. Don’t let pain and uncertainty take their toll on your daily life. Take the first step towards better health: book an appointment at for a specialist gastroenterology consultation, and leave the examination to the experts. Your health and peace of mind are our top priority.
