Epigastric pain affects the middle of the upper abdomen, just below the ribcage. It is common during pregnancy. Other causes include indigestion, acid reflux and GERD, peptic ulcer disease, and more.

There are many common digestive problems associated with epigastric pain, as well as a range of other underlying conditions that can cause pain in that area.

Serious cases may be life-threatening, and it is important to work with a doctor to understand the difference between a simple cause of epigastric pain and a more serious underlying condition.

Epigastric pain is a common symptom of an upset stomach, which can be due to long-term gastrointestinal problems or just the occasional bout of indigestion.

1. Indigestion

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Epigastric pain is felt just under the ribcage and is generally not a cause for concern.

Indigestion usually occurs after eating. When a person eats something, the stomach produces acid to digest the food. Sometimes, this acid can irritate the lining of the digestive system.

Indigestion can cause symptoms such as:

  • burping
  • bloating in the abdomen
  • feeling full or bloated, even if the portion size was not big
  • nausea

These symptoms are often felt alongside epigastric pain. While indigestion happens to everyone from time to time, it may be a sign that a person is intolerant of something they have recently eaten.

2. Acid reflux and GERD

Acid reflux occurs when the stomach acid used in digestion gets backed up in the food pipe (esophagus). Acid reflux usually causes pain in the chest and throat, which is commonly known as heartburn. This feeling may accompany epigastric pain or be felt on its own.

Other common symptoms of acid reflux include:

  • indigestion
  • burning or aching chest pain
  • feeling like there is a lump in the throat or chest
  • an acidic or a vomit-like taste in the mouth
  • a persistent sore throat or hoarse voice
  • a persistent cough

Ongoing acid reflux can damage the food pipe and may cause gastroesophageal reflux disease, or GERD. People with GERD experience epigastric pain and symptoms of indigestion frequently and may require treatment and dietary changes to manage the condition.

Some cases of GERD can lead to a condition called Barrett’s esophagus, where the tissue of the food pipe starts to look like the tissue in the intestines.

3. Overeating

The stomach is very flexible. However, eating more than necessary causes the stomach to expand beyond its normal capacity.

If the stomach expands considerably, it can put pressure on the organs around the stomach and cause epigastric pain. Overeating can also cause indigestion, acid reflux, and heartburn.

4. Lactose intolerance

Lactose intolerance can be another cause of epigastric pain. People who are lactose intolerant have trouble breaking down lactose, a sugar found in milk and other dairy products.

For people with lactose intolerance, eating dairy can cause epigastric pain and other symptoms, including:

  • stomach pains
  • cramps and bloating
  • gas
  • nausea or vomiting
  • diarrhea

5. Drinking alcohol

Moderate drinking is usually not enough to upset the stomach or intestines. However, drinking too much alcohol at once or excess alcohol over long periods of time can cause inflammation in the lining of the stomach. This inflammation can lead to epigastric pain and other digestive issues.

6. Esophagitis or gastritis

Esophagitis is inflammation of the lining of the food pipe. Gastritis is inflammation of the lining of the stomach. Esophagitis and gastritis can be caused by acid reflux, infections, and irritation from certain medications. Some immune system disorders may also cause inflammation.

If this inflammation is left untreated, it can create scar tissue or bleeding. Other common symptoms include:

  • acidic or vomit-like taste in the mouth
  • persistent cough
  • burning in the chest and throat
  • trouble swallowing
  • nausea
  • vomiting or spitting up blood
  • poor nutrition

7. Hiatal hernia

A hiatal hernia occurs when part of the stomach pushes up through the diaphragm and into the chest. This may be due to an accident or weakened diaphragm muscles.

In addition to epigastric pain, other common symptoms of hiatal hernias include:

  • sore throat
  • irritation or scratchiness in the throat
  • trouble swallowing
  • gas or especially loud burps
  • chest discomfort

Hiatal hernias typically affect older people and may not cause epigastric pain in every case.

8. Peptic ulcer disease

Peptic ulcer disease is when the lining of the stomach or small intestine has been damaged by a bacterial infection or by taking too much of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs).

Symptoms of peptic ulcer disease can include epigastric pain and signs of internal bleeding, such as stomach pain, fatigue, and shortness of breath.

9. Gallbladder disorder

Issues with the gallbladder may also cause epigastric pain. Gallstones may be blocking the opening of the gallbladder, or the gallbladder may be inflamed. Specific gallbladder symptoms can include:

  • intense pain near the upper right side of the stomach after eating
  • clay-colored stool
  • jaundice or yellowing skin
  • loss of appetite
  • gas and bloating

10. Pregnancy

It is very common to feel mild epigastric pain during pregnancy. This is commonly caused by acid reflux or pressure on the abdomen from the expanding womb. Changes in hormone levels throughout pregnancy can also aggravate acid reflux and epigastric pain.

Severe or persistent epigastric pain during pregnancy can be a sign of a more serious condition, so a woman should visit her doctor if experiencing any unusual symptoms.

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An endoscopy may be carried out to find the cause of unexplained epigastric pain.

Diagnosing the cause of epigastric pain is essential to ensure proper treatment. A healthcare professional will likely ask a series of questions about the pain and any additional symptoms.

If the cause is unclear, they may order tests, including:

  • imaging tests, such as X-rays, ultrasound, or an endoscopy
  • urine tests to check for infections or bladder disorders
  • blood tests
  • cardiac tests

Treating epigastric pain will vary according to the cause. For instance, if overeating frequently causes epigastric pain, a person may wish to eat smaller portions and ensure they are eating filling foods, such as lean proteins. They may also want to avoid foods that cause gas.

Conditions such as GERD, peptic ulcers, and Barrett’s esophagus may require long-term treatment to manage symptoms. A person should work with their doctor to find a treatment plan that works for them.

If a doctor thinks that taking certain medications is causing the condition, they may recommend switching to a new drug or reducing the dosage.

Over-the-counter or prescription antacids to help reduce frequent acid reflux and epigastric pain caused by stomach acid may be helpful.

Occasional epigastric pain is not usually a cause for concern, but anyone with severe or persistent epigastric pain should see their doctor.

Symptoms that last more than a few days or that occur more than twice a week on a regular basis would be considered persistent.

A visit to the emergency room may be necessary in some cases. Signs of severe complications that require prompt treatment include:

  • difficulty breathing or swallowing
  • intense pressure or squeezing pain in the chest
  • coughing up blood
  • blood in the stool
  • nausea, vomiting, or diarrhea lasting more than 24 hours in adults
  • high fever
  • extreme fatigue or loss of consciousness

Many cases of epigastric pain can be treated and prevented by making small changes in the diet or lifestyle. Even chronic symptoms can be managed well with medications and dietary changes.