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That uncomfortable feeling in your upper abdomen, just below the ribs? That’s epigastric pain. More often than not, it’s a sign of something straightforward like indigestion, acid reflux, or gastritis (a fancy term for an inflamed stomach lining). Think of it as a direct message from your digestive system telling you something isn't quite right.
Imagine your epigastric area as a busy central hub for your gut. It’s where your stomach, oesophagus, and even neighbouring organs like the pancreas and gallbladder all connect. So when you feel a pang of pain there, it’s your body’s way of raising a flag – and it’s one you shouldn’t ignore.
The feeling itself can range from a dull ache to a sharp sting or a burning sensation. While it's usually harmless, it can be unsettling simply because there are so many potential causes. Getting to grips with what might be triggering this discomfort is the first real step towards finding relief.
If you're experiencing this, you're definitely not alone. Digestive issues are incredibly common across the UK and can easily get in the way of daily life.
One survey of 516 UK adults revealed that a staggering 86% had experienced at least one gastrointestinal problem, with 57% reporting specific abdominal pain. For many, it's a frequent occurrence: 41% had symptoms daily, and 38% felt them more than once a day. If you want to read more about common digestive problems, you can find helpful information about various gastrointestinal symptoms on our website.
The sheer frequency of these symptoms just goes to show how sensitive our digestive systems can be to diet, stress, and underlying health conditions. Realising how common this is can help take the edge off the anxiety and let you focus on figuring out the specific cause.
This widespread reality really highlights why you shouldn't just brush off persistent discomfort. To help you start connecting the dots, we've put together a quick guide to the usual suspects.
This table gives you a simple, at-a-glance overview of the most frequent culprits behind that upper abdominal ache. It’s a great starting point for matching your symptoms to potential causes.
This guide is designed to lay a solid foundation. While it's a helpful starting point, remember that only a healthcare professional can give you a proper diagnosis. In the next sections, we’ll dive deeper into each of these conditions.
Epigastric discomfort often presents as a burning or squeezing sensation just below the ribs. When you understand what’s behind that ache, you can target relief more effectively.
One of the most frequent offenders is Gastro-Oesophageal Reflux Disease (GORD). Imagine a trapdoor at the bottom of your oesophagus that won’t shut—acid then splashes back up, irritating the lining and triggering that familiar burn.
About 20% of UK adults report heartburn weekly, putting GORD at the top of the list for epigastric pain.
Common Signs Of GORD
Certain foods and habits can loosen that trapdoor or crank up acid production:
Pinpointing and avoiding these triggers can dramatically cut down reflux episodes.
Gastritis feels like someone scraped at your stomach lining—an irritation affecting around 15% of adults each year, often due to H. pylori, painkillers or excess alcohol.
If that irritation digs deeper, it can form a peptic ulcer—a small crater that may bleed or burn. Peptic ulcers occur in about 10% of people and need treatment to prevent serious complications.
Key Concept: Gastritis often presents as a dull, diffuse ache, whereas ulcers deliver a sharper, more intense burn.
Even without visible damage, functional dyspepsia can cause real pain. It affects up to 25% of people and often links to stress or anxiety.
Look out for:
Tests may be clear, but the discomfort is genuine.
Pancreatitis arises when digestive enzymes turn on the pancreas itself, leading to intense epigastric pain that often radiates to the back.
That hierarchy diagram highlights how inflammation and acid injury underlie most forms of epigastric pain.
Treatment depends on the diagnosis but often includes:
Lifestyle tweaks—mindful eating, stress management and simple breathing exercises—often enhance medical therapies.
You might be interested in our article on high-fibre carbohydrate benefits for your gut and heart to support overall digestive wellness.
Conditions like acid reflux are frequent culprits of epigastric pain, and there are various approaches to manage them, including exploring herbal remedies for acid reflux as a helpful resource.
Small changes in routine can make a big difference:
For example, Mark—a 45-year-old office worker—swapped his morning espresso for peppermint tea and noticed his epigastric burning eased within days.
Next, we’ll explore how issues in neighbouring organs might also lead to upper abdominal discomfort.
While your stomach often gets the blame for that nagging pain below your breastbone, it’s sometimes just the messenger. The upper abdomen is a tightly packed neighbourhood of vital organs, and when one of them runs into trouble, the pain signals can show up centrally in the epigastric region. This is a classic case of referred pain, where your brain gets its wires crossed and tells you the pain is in one spot, even though the real problem is somewhere else.
It’s crucial to understand these other potential sources because the cause could be anything from a minor digestive hiccup to a serious condition needing urgent medical attention. A good doctor will always consider this interconnected anatomy when figuring out what’s really going on.
One of the most common culprits behind severe epigastric pain is the gallbladder. This small, pear-shaped organ is tucked away under your liver and its main job is to store and concentrate bile, the fluid your liver makes to help break down fatty foods.
Problems start when substances in the bile, like cholesterol, harden into gallstones. These can be as tiny as a grain of sand or as large as a golf ball.
You can have gallstones for years and never know it. The trouble begins when a stone gets dislodged and blocks a bile duct. This blockage causes bile to back up, creating intense pressure and inflammation.
This is a condition known as biliary colic, and it typically causes a severe, cramping pain in the upper right side of your abdomen. But very often, the pain radiates to the centre, feeling like a sharp epigastric pain. You might even feel it in your back or right shoulder blade.
Key signs of gallstone pain include:
Think of a gallstone blockage like a dam suddenly appearing in a river. The pressure builds rapidly, causing the gallbladder to swell and send out intense pain signals that are felt across the upper abdomen.
Tucked just behind the stomach is the pancreas, a gland that’s a real powerhouse, producing crucial digestive enzymes as well as hormones like insulin. When the pancreas gets inflamed—a condition called pancreatitis—it causes a very distinctive and often agonising epigastric pain.
Unlike the sharp, cramping pain of gallstones, the pain from acute pancreatitis is typically a deep, constant, and boring ache. Many people describe it as feeling like it’s piercing straight through to their back.
This inflammation happens when digestive enzymes activate while they’re still inside the pancreas, essentially causing the organ to start digesting itself. The most common triggers are gallstones and excessive alcohol consumption.
Symptoms to watch for with pancreatitis are:
Acute pancreatitis is a serious medical issue that often requires hospitalisation. Diagnosing and managing conditions like this may involve a specialist in general surgery. You can find more information about our expert general surgery team and services if you have concerns about conditions affecting your abdominal organs.
The liver, your body’s largest internal organ, takes up most of the upper right part of your abdomen. While liver problems don’t always cause pain, some issues can lead to a dull, persistent ache in the epigastric region.
Conditions like hepatitis (liver inflammation) can cause the organ to swell. This swelling stretches the sensitive membrane surrounding the liver, known as Glisson's capsule, which is full of nerve endings.
It’s this stretching that creates the sensation of pain. It’s usually not a sharp, stabbing feeling but more of a constant, vague discomfort or a sense of fullness in the upper abdomen. The pain might be more noticeable on the right side, but it can easily be felt centrally.
This just goes to show how challenging it can be to diagnose epigastric pain, which is a frequent reason for hospital visits in the UK. One study at Aberdeen Royal Infirmary found that patients with non-specific abdominal pain had a median of four unscheduled hospital visits over two years, with the financial burden averaging around £14,478 per patient. You can explore the full findings on the impact of non-specific abdominal pain on healthcare resources.
While that nagging pain in your upper abdomen usually points to something in your digestive system, it’s crucial to know about a serious, and often overlooked, connection. That discomfort can sometimes be a warning sign from your heart, and it's not something to take lightly—especially if you have any risk factors for heart disease.
The reason for this potential mix-up is all down to our body’s wiring. The nerves sending pain signals from the stomach and the heart are bundled close together. When the heart is under stress, like during a heart attack, the pain signals it sends out can get misinterpreted by the brain. It reads the signal as coming from the stomach, making you think you have indigestion when it’s actually a cardiac event.
This crossover is why heart attack symptoms can be so varied and misleading. Understanding this is a vital piece of knowledge that could genuinely save a life.
So, how can you tell the difference between a simple case of heartburn and dangerous cardiac pain? The key is to look at the bigger picture—what other symptoms are there, and what was happening when the pain started?
Indigestion typically feels like a burning sensation after you’ve eaten. Cardiac-related pain, on the other hand, often behaves differently. A major clue is the link between the pain and physical activity.
If your epigastric pain flares up with exertion—like climbing the stairs—and then eases off when you rest, that’s a huge red flag for a heart issue. This pattern suggests your heart isn't getting enough oxygen when it has to work harder.
It's essential to remember that heart-related pain doesn't always feel like the classic "crushing chest pain" often depicted. It can present as pressure, squeezing, or a vague ache in the upper abdomen, making it easy to dismiss.
If your epigastric pain comes with any of the following symptoms, you need to seek emergency medical help straight away. Don't wait to see if it improves on its own.
These are potential signs of a heart attack or another serious cardiac problem:
Recognising these red flags is incredibly important. While it might turn out to be a digestive issue, the risk of ignoring a potential heart attack is far too great. If you have a history of heart disease, high blood pressure, high cholesterol, or diabetes, you should be especially vigilant. Our guide on recognising the signs of chest pain can provide further clarity. Always err on the side of caution and let a medical professional make the diagnosis.
While many causes of epigastric pain are mild and manageable, some symptoms are your body's way of sounding a serious alarm. It's time to stop self-diagnosing and get professional medical advice.
Knowing these red flags is crucial. It helps you cut through the anxiety and take clear, decisive action for your health. But how do you know whether to book a GP appointment or head straight to A&E? The key is to look beyond the pain itself and listen to the other signals your body is sending.
Some symptoms are simply too serious to "wait and see". If your epigastric pain comes with any of the following, you should treat it as a medical emergency. These signs can point to severe issues like a perforated ulcer, acute pancreatitis, or even a heart attack.
Call 999 or go to your nearest Accident & Emergency (A&E) department if you experience:
It’s vital to act quickly in these situations. Knowing the right place to go matters; understanding whether you need an emergency room or urgent care can help you make the right choice in a moment of crisis. When in doubt, always aim for the highest level of care.
Not every symptom requires an emergency dash to the hospital, but that doesn't make it any less important. Certain signs warrant a prompt visit to your GP for a proper diagnosis and treatment plan. These suggest an ongoing issue that needs looking into to rule out conditions like chronic gastritis, peptic ulcers, or GORD.
Book an appointment with your doctor if your epigastric pain is persistent and you also have:
Abdominal pain is incredibly common and can be triggered by a huge range of factors, which is why a professional diagnosis is so important. For example, data from the COVID-19 Infection Survey in England showed a significant number of people reported abdominal symptoms during the pandemic. This highlights how even infections can complicate the picture, reinforcing the need for a proper medical evaluation.
When you’re dealing with discomfort in your upper abdomen, it’s only natural to have questions about what’s causing it and how your daily habits might be playing a part. Getting clear, straightforward answers can make a huge difference in how you manage your symptoms and when to seek help.
Here, we’ll tackle some of the most common concerns people have, from the link between stress and stomach pain to what to expect when you see a specialist.
Yes, absolutely. There's a powerful connection between your brain and your gut, often called the gut-brain axis. Think of it as a two-way street where your emotional state directly influences your digestive system.
When you’re stressed or anxious, your body releases a flood of stress hormones. This isn’t just a feeling in your head; it has real, physical effects on your stomach.
These hormones can:
This is the science behind what people often call a "nervous stomach." It's a key factor in conditions like functional dyspepsia, where the pain is very real even if there's no visible ulcer or inflammation. That’s why managing stress through mindfulness, exercise, or therapy can often bring genuine physical relief.
While everyone has different triggers, some foods are notorious for causing problems, especially if you have GORD or gastritis. They tend to work in one of a few ways: they either ramp up stomach acid, relax the valve that keeps acid down, or directly irritate the lining of your stomach.
Common culprits to watch out for include:
The best approach is to become your own food detective. Try keeping a simple diary for a couple of weeks, noting what you eat and when symptoms flare up. This will help you pinpoint your personal triggers and build a diet that keeps you comfortable.
When you see a doctor for epigastric pain, they’ll start by piecing together the clues to figure out what’s going on. The first step is always a detailed conversation.
Your doctor will want to know the specifics of your pain:
Next comes a physical examination. The doctor will gently press on different areas of your abdomen to check for tenderness, swelling, or firmness. This simple step can give important clues about which organs might be inflamed or causing trouble.
If the picture isn't clear from this initial assessment, your doctor will likely recommend further tests to get a definitive answer.
Common diagnostic tests include:
Each step in this diagnostic journey helps to narrow down the many potential causes of epigastric pain, ensuring you get the right diagnosis and the most effective plan for treatment.
At The Vesey, our specialists are dedicated to providing exceptional care and accurate diagnostics for all gastrointestinal concerns. If you are experiencing persistent epigastric pain, our team is here to help you find answers and relief. Explore our patient services and book a consultation.
