Brief summary: Epigastric pain is a discomfort felt below the breastbone, in the upper central part of the abdomen. The most common causes are functional dyspepsia, gastro-oesophageal reflux disease, gastric or duodenal ulcers, and Helicobacter pylori infection. An accurate diagnosis is made by gastroscopy, particularly in the presence of warning symptoms.
Many people are familiar with the sensation of a burning, pressing or cramping pain in the stomach area. Stomach pain is one of the most common complaints that lead people to see a doctor — according to some surveys, nearly 20% of the adult population experience such symptoms. There can be many different causes behind this complaint, ranging from harmless indigestion to more serious illnesses.
In this article, we provide a comprehensive overview of the causes, typical symptoms and warning signs of abdominal pain. We also explain which tests can help establish an accurate diagnosis, and when it is advisable to consult a specialist. Our aim is to provide clear and reliable information to help you make sense of your symptoms.
What is epigastric pain?
Pain in the upper abdomen — medically known as epigastric pain — is pain or discomfort felt in the upper, central part of the abdomen, in the area below the breastbone. Commonly used related terms include upper abdominal pain, stomach pain, and dyspnoea, which describes the combination of these symptoms.
Pain can take many forms. Symptoms attributable to gastrointestinal causes typically present as a dull, burning or gnawing sensation. The pain may be constant or come and go, and is often related to eating.
What causes pain in the stomach area?
There are many possible causes of pain in the stomach area. The most common causes are summarised below.
Functional dyspepsia
The most common cause of chronic epigastric pain is functional dyspepsia, which accounts for 60–75% of cases. In such cases, investigations reveal no tangible organic lesions. The underlying causes are often stress associated with modern lifestyles and increased gastric sensitivity. The two main subtypes of the condition are the form characterised by a feeling of fullness after eating (PDS) and the form characterised by pain unrelated to eating (EPS).
Stomach and duodenal ulcers
Peptic ulcer disease is damage to the mucous membrane of the stomach or duodenum. Most ulcers are caused by infection with the bacterium Helicobacter pylori or by long-term use of non-steroidal anti-inflammatory drugs (NSAIDs, such as painkillers). The two types of ulcer show different patterns:
- Stomach ulcer: The pain worsens after meals and is often accompanied by a feeling of fullness, belching, nausea and an inability to tolerate fatty foods.
- Duodenal ulcer: „Classic” pain occurs 2–5 hours after a meal and at night, and is temporarily relieved by eating.
Reflux disease (GERD)
Gastro-oesophageal reflux disease is one of the most common digestive disorders, affecting 10–20% of the Western population. Its most characteristic symptom is heartburn, that is, a burning sensation behind the breastbone, which may be accompanied by acid reflux. The condition is often triggered by bending forward or by consuming certain foods and drinks.
Helicobacter pylori infection
Helicobacter pylori is a bacterium that colonises the stomach lining and can cause inflammation and ulcers. It is detectable in 70–90% of duodenal ulcers and 30–60% of gastric ulcers. The presence of the bacterium can be confirmed from a sample taken during gastroscopy or by means of a breath test.
Other reasons
Pain in the upper abdomen can also be caused by conditions affecting other organs. These include pancreatitis (where the pain radiates into the back), gallstones and cholecystitis (pain radiating to the area below the right ribcage and into the back), and gastritis.
What risk factors increase the likelihood of symptoms?
Certain habits and factors increase the likelihood of developing pain in the stomach area:
- Regular use of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin
- Helicobacter pylori infection
- Smoking — smokers are twice as likely to develop an ulcer
- Chronic stress
- aged 60 or over
- Concomitant treatment with anticoagulants or steroids
What are the warning signs?
Pain in the upper abdomen does not usually indicate a serious illness. However, there are certain accompanying signs that require immediate medical attention. These are known as warning or alarm symptoms:
- Unexplained weight loss and loss of appetite
- Difficulty swallowing (dysphagia) or painful swallowing
- Gastrointestinal haemorrhage Symptoms: fresh or coffee-ground-like vomit, or black, tar-like stools
- Anaemia (anaemia), often accompanied by fatigue
- Recurrent vomiting
- New symptoms that arise in later life
These symptoms may indicate complications from an ulcer or, less commonly, a cancerous lesion; therefore, you should not delay having it checked.
How can the cause of stomach pain be identified?
An accurate diagnosis is based on a detailed medical history and targeted investigations. Gastroscopy and testing for Helicobacter pylori play the most important role in the investigation of epigastric symptoms.
Gastroscopy
Upper gastrointestinal endoscopy, commonly known as a gastroscopy, is the most accurate method for investigating epigastric pain. During the examination, the doctor uses a thin, flexible instrument fitted with a camera to directly view the mucous membranes of the oesophagus, stomach and duodenum. The advantages of gastroscopy:
- Detects ulcers, inflammation and other abnormalities of the mucous membrane
- It enables histological sampling (biopsy)
- It can confirm a Helicobacter pylori infection
- Rules out a malignant lesion
A gastroscopy is particularly indicated if warning symptoms are present, if symptoms develop in people aged 50–60 or older, or if they persist despite treatment.
Helicobacter pylori screening
The bacterium can be detected using a breath test, a faecal antigen test or a sample taken during gastroscopy. If the result is positive, targeted antibiotic treatment (eradication) is recommended.
A painless form of the examination
Many people are afraid of the discomfort associated with a gastroscopy. The solution to this is the GASTROSCOPY UNDER ANAESTHESIA, during which the patient sleeps through the entire procedure and is completely unaware of it. At Endomedix, for professional reasons, we use general anaesthesia exclusively, rather than sedation: the procedure is supervised by an experienced anaesthetist, who monitors the patient’s vital signs throughout.
Endomedix’s expertise in the investigation of abdominal symptoms
Endomedix’s gastroenterology centres specialise in the accurate diagnosis of digestive system disorders, including abdominal pain. Our experienced specialist gastroenterologists work with state-of-the-art videoendoscopy equipment, which provides high-resolution, real-time images of the condition of the mucous membrane. This enables us to detect even the smallest abnormalities.
As well as making an accurate diagnosis, our specialists draw up a personalised treatment plan and provide practical advice on lifestyle and diet to help alleviate your symptoms. If you are experiencing persistent pain in the stomach area, Book an appointment for a consultation with a gastroenterologist at Endomedix, where our specialists will assess your symptoms and arrange the appropriate tests.
What can you do to alleviate the symptoms?
In addition to receiving a diagnosis and undergoing treatment, a few lifestyle changes may also help:
- Avoid foods that trigger symptoms (fatty, spicy or sour dishes)
- Eat smaller portions, more frequently
- Do not eat large meals before going to bed
- Cut down on smoking and alcohol consumption
- Only take painkillers when necessary
When should you see a doctor?
Pain in the upper abdomen can usually be treated and does not indicate a serious illness. However, if your symptoms persist, do not improve despite treatment, or are accompanied by warning signs (weight loss, difficulty swallowing, bleeding, anaemia), you should definitely consult a specialist. Early diagnosis is crucial, as most upper abdominal complaints can be treated effectively if detected in time.
Frequently asked questions
What is the difference between stomach pain and heartburn?
Epigastric pain is a dull, burning or cramping sensation in the upper, central part of the abdomen. Heartburn, on the other hand, is a burning sensation behind the breastbone caused by the backflow of acidic stomach contents. Heartburn is often a symptom of gastro-oesophageal reflux disease (GORD) and can be one form of epigastric pain.
How long does a gastroscopy take?
The optimal duration of a diagnostic gastroscopy is only about 7 minutes. In the case of a procedure under general anaesthesia, the entire process — from arrival to waking up — takes longer than this, but the patient is unaware of any of the actual procedure.
Is pain in the stomach area dangerous?
In most cases, no. The symptoms are usually caused by functional dyspepsia, reflux or an ulcer, all of which can be treated effectively. However, if there are warning signs — such as weight loss, difficulty swallowing, bleeding or anaemia — a prompt medical examination is necessary.
What can I eat if I have pain in my upper abdomen?
It is recommended that you prioritise easily digestible foods, eaten in smaller portions. Avoid fatty, spicy and sour dishes, as well as alcohol and coffee, as these may exacerbate your symptoms. It is advisable to consult a specialist or dietitian for specific dietary advice.
When is a gastroscopy needed?
A gastroscopy is indicated if warning symptoms are present, if symptoms develop in people aged 50–60 or older, or if the pain persists despite treatment. The examination accurately detects ulcers, inflammation and Helicobacter pylori infection.
