EPIGASTRALGIA (EPIGASTRIC PAIN): SYMPTOMS, CAUSES, TREATMENTS - MEDICINE - 2025

The epigastric pain is pain that occurs in the abdomen, in the middle and just below the ribs and sternum. More than a disease, it is a symptom and can be caused by different causes.

Although in most cases epigastralgia can resolve spontaneously and with home treatments, when it lasts a long time or there is no relief, it is best to go to the doctor for a detailed examination and thus determine the cause in order to treat it.

Source: pixabay.com

In young people, epigastralgia is most often associated with gastritis (inflammation of the stomach lining) and gastroesophageal reflux disease (part of the acidic content of the stomach is returned to the esophagus causing it to become irritated).

In older people it is possible that in addition to the conditions mentioned above, gastric ulcers, duodenal ulcers and in some cases even stomach cancer may occur.

Although the problem that causes epigastralgia is usually found in the upper digestive tract (esophagus, stomach, duodenum), it is also possible that some people with disease of the gallbladder (bile duct) or the colon (lower digestive tract) have this symptom.

Symptoms and their characteristics

Talking about the symptoms of epigastralgia can be redundant since epigastralgia is a symptom in itself, so it is best to talk about the "characteristics of the symptom."

In this sense, epigastralgia is characterized by being a pain located in the midline of the abdomen, in the highest part, just below the ribs and sternum. Colloquially, some people often describe the pain as "the pit of the stomach" although this term is not very technical and is never used in the clinical context.

The characteristics of pain in epigastric pain are variable, the most common being that the pain is similar to burning (burning pain) or pressure (oppressive pain).

Pain episodes or attacks can be sporadic (a few times a month) or recurrent (several times a week), while the duration of each attack can be from a few minutes to lasting several hours.

Epigastralgia can present as an isolated symptom or be associated with other symptoms such as nausea, vomiting, and even retrosternal pain.

Causes

As mentioned previously, epigastric pain can be produced by multiple causes, being almost impossible to describe all of them in detail, however a walk through the most common ones will allow you to have a fairly clear idea of ​​the associated diseases.

In general terms, it can be said that the main cause of epigastric pain is gastritis, closely followed by gastric ulcer. In second place are gastroesophageal reflux disease and duodenal ulcer, followed in third place by diseases of the gallbladder (usually stones or stones) and diseases of the colon (large intestine).

In addition to the common conditions mentioned above, other diseases or conditions such as esophageal spasm, pancreatitis and even myocardial infarction can also cause epigastric pain.

We take a closer look at the most common causes:

Gastritis

Gastritis is understood to be the inflammation of the innermost wall of the stomach (known as the mucosa) as a result of the irritating effect of some food, chemical or medicine.

The causes of gastritis are very numerous, although the first and most frequent of all is stress. When a person is under a lot of physical or emotional tension (known colloquially as stress) a series of chemical mediators are produced that increase the acidity of the gastric juice, making it capable of irritating the stomach lining.

In addition to stress, some foods such as spicy, consumed in excess or in a habitual way, can irritate the lining of the stomach, as can many drinks, especially alcohol.

On the other hand, many chemicals, especially drugs, can irritate the stomach lining causing gastritis and therefore epigastric pain. In general, sporadic use of the drug will not produce major consequences, but if consumption is prolonged over time, gastritis symptoms usually appear sooner or later.

Regardless of the cause, all cases of gastritis present epigastralgia accompanied or not by other symptoms such as nausea and vomiting.

Gastric ulcer

It could be considered as the second step in the evolution of gastritis, since gastric ulcers occur when the inflammation is so intense that it erodes the gastric mucosa, producing a small wound, which instead of healing tends to worsen with the weather.

Gastric ulcer is generally associated with epigastralgia, although it can also be associated with other symptoms such as vomiting, nausea and even upper gastrointestinal bleeding (vomiting with blood), in these cases it is very important to consult a doctor to correct the problem before they occur serious complications.

Gastroesophageal reflux disease

Under normal conditions, once the food passes from the esophagus to the stomach, a kind of muscular valve known as "cardia" closes which prevents the acidic content of the stomach from passing into the esophagus.

When this protective mechanism of the esophagus fails, part of the gastric acid passes into the esophagus where it produces severe irritation and inflammation of the esophageal mucosa, since it does not have the defense mechanisms against such an intense chemical attack.

Although most people with gastroesophageal reflux are asymptomatic, when they present some type of clinical manifestation this is usually epigastric pain, accompanied or not by retrosternal pain.

Duodenal ulcer

Once the food goes through the second stage of digestion in the stomach, it passes into the duodenum for the third stage. The duodenum is where the intestine begins and the pH changes from acidic to alkaline making the mucosa of this portion of the small intestine very vulnerable to chemical attack.

Thus, it is common for the duodenal mucosa to become inflamed leading to duodenitis (inflammation of the duodenal mucosa) and then to duodenal ulcer, both associated with epigastric pain.

Stomach cancer

Of all the causes of epigastralgia, this can be considered one of the most worrisome given the risk it implies for the patient.

Although asymptomatic in most cases, when it presents any clinical manifestation it is usually epigastric pain. In general, people with stomach cancer have a history of abdominal pain for weeks or months, which improves with self-medication, but reappears progressively increasing in intensity.

Other symptoms may occur, although all are nonspecific, making it necessary to consult a specialist in order to reach a definitive diagnosis and establish the appropriate treatment.

Diagnosis

The diagnostic approach to the patient with epigastric pain should always be based on the medical history since the characteristics, duration and intensity of the symptom can guide with great precision towards the determination of the cause.

On the other hand, the physical examination rarely provides relevant data, so it is necessary to carry out complementary studies in order to reach a definitive diagnosis.

Of all the available tests, Upper Digestive Endoscopy (EDS) is the most accurate, since in addition to allowing direct visualization of the upper digestive tract, it is also useful for taking biopsies and samples of gastric content for biochemical studies.

As a complement and in very rare cases, it may be necessary to perform an abdominal ecosonogram (ultrasound), especially when it is necessary to rule out associated gallbladder disease; Likewise, when colon disease is suspected, a colonoscopy may be necessary.

Both EDS and colonoscopy are specialized studies that must be performed by a trained and experienced gastroenterologist.

Forecast

The prognosis of epigastralgia will largely depend on the cause of it. In most cases, the prognosis of patients with epigastric pain is very favorable, since the causes are usually mostly benign.

However, we must not forget that ulcers (both gastric and duodenal) can bleed, thus putting the patient's life at risk; Likewise, in cases of epigastric pain secondary to stomach cancer, the prognosis is less favorable and will be associated with the prognosis of the cancer itself.

Treatment

Regarding the treatment of epigastralgia, it is important to note that it is divided into two types: general treatment and specific treatment.

General treatment

The general treatment of epigastralgia is one that is applied to all patients in order to relieve symptoms, regardless of what is causing the abdominal pain.

The measures range from changes in the eating pattern avoiding the consumption of certain foods, to preventing reflux (avoiding going to bed immediately after eating) to the use of various medications aimed at improving symptoms.

Of the available drugs, the most popular are contact antacids, which consist of solutions that are administered orally so that once in the digestive tract they neutralize gastric acid and thus improve symptoms.

On the other hand, there are the inhibitors of acid secretion from the stomach, the most popular being the H2 receptor inhibitors, such as ranitidine, as well as the proton pump blockers (omeprazole, esomeprazole, pantoprazole, etc.).

Both H2 blockers and proton pump blockers inhibit acid secretion in the stomach, thus helping to relieve symptoms associated with epigastric pain.

It is important to note that conventional analgesics, especially non-steroidal anti-inflammatory drugs (NSAIDs), are not usually useful to improve pain and, on the contrary, can worsen the clinical picture since they are usually associated with irritation of the gastric mucosa.

Specific treatment

The specific treatment of epigastric pain will depend on the underlying disease associated with it, in this way the range of options is very wide, and ranges from drug treatment with ranitidine or omeprazole for gastritis cases, to extensive surgery for cases of stomach cancer.

Generally speaking, the specific treatment is that aimed at improving or curing (when this is possible) the disease that is causing epigastric pain, this being an individualized treatment according to the clinical characteristics of each particular patient.

References

1. Rodríguez-Lago, I., & Cabriada, JL (2016). Diagnostic protocol for acute epigastric pain. Medicine-Accredited Continuing Medical Education Program, 12 (2), 92-95.
2. Hashimoto, S., Futagami, S., Yamawaki, H., Kaneko, K., Kodaka, Y., Wakabayashi, M. & Ueki, N. (2017). Epigastric pain syndrome accompanying pancreatic enzyme abnormalities was overlapped with early chronic pancreatitis using endosonography. Journal of clinical biochemistry and nutrition, 17-41.
3. Laine, L., Ahnen, D., McClain, C., Solcia, E., & Walsh, JH (2000). potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors. Alimentary pharmacology & therapeutics, 14 (6), 651-668.
4. Xue, S., Katz, PO, Banerjee, P., Tutuian, R., & Castell, DO (2001). Bedtime H2 blockers improve nocturnal gastric acid control in GERD patients on proton pump inhibitors. Alimentary pharmacology & therapeutics, 15 (9), 1351-1356.
5. Miner, TJ, Jaques, DP, Karpeh, MS, & Brennan, MF (2004). Defining palliative surgery in patients receiving noncurative resections for gastric cancer. Journal of the American College of Surgeons, 198 (6), 1013-1021.