Epigastric Pain: Causes, Symptoms and When to See a Doctor
Epigastric pain — that discomfort in your upper abdomen — is one of the most common complaints seen in private clinics. Here's what could be causing it.
That uncomfortable feeling in your upper abdomen, just below the ribs, is epigastric pain. More often than not, it's a sign of something straightforward like indigestion, acid reflux, or gastritis — inflammation of the stomach lining. Think of it as a direct message from your digestive system.
Understanding Your Epigastric Pain
Your epigastric area is where your stomach, oesophagus, and neighbouring organs like the pancreas and gallbladder all connect. The feeling can range from a dull ache to a sharp sting or burning sensation. A UK survey of 516 adults found that 86% had experienced at least one gastrointestinal problem, with 57% reporting specific abdominal pain.
Common Digestive Causes
- Acid reflux (GORD) — heartburn after meals, sour taste, affects ~20% of UK adults weekly
- Gastritis — inflamed stomach lining, causes burning ache, nausea, bloating
- Peptic ulcer — sharp, gnawing pain between meals or at night
- Functional dyspepsia — persistent discomfort despite normal test results, affects up to 25% of people
- Pancreatitis — severe pain radiating to the back, worse after eating, requires urgent care
When Nearby Organs Are the Culprit
Gallstones are one of the most common causes of severe epigastric pain. A blocked bile duct causes intense, cramping pain in the upper right abdomen that radiates to the centre. Key signs: sudden onset after a fatty meal, lasting 30 minutes to several hours, with nausea.
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The liver, when inflamed by conditions like hepatitis, can also cause a dull upper abdominal ache that radiates to the epigastric region.
Could It Be Your Heart?
Crucially, epigastric pain can sometimes be a warning sign from the heart. Seek emergency care immediately if your epigastric pain is accompanied by: shortness of breath, sweating, pain spreading to the jaw or left arm, dizziness, or extreme fatigue. These are potential signs of a cardiac event.
Epigastric Pain Red Flags: When to Seek Urgent Help
Seek emergency medical attention immediately if epigastric pain is accompanied by:
- Chest tightness, jaw pain, or pain spreading to the left arm — possible cardiac emergency
- Sudden severe pain radiating through to the back — possible pancreatitis or aortic emergency
- Vomiting blood (haematemesis) or black, tarry stools (melaena)
- Yellowing of the skin or eyes (jaundice) with fever
- Collapse, sweating, or signs of shock
- Rapid unexplained weight loss over weeks to months
- Progressive difficulty swallowing
Epigastric Pain Radiating to the Back
Pain that begins in the epigastric region and radiates through to the mid-back is a particularly important symptom. The two most clinically significant causes are acute pancreatitis — in which inflammation produces severe, boring pain that radiates horizontally to the mid-back — and posterior peptic ulcer disease. Aortic aneurysm and biliary disease may also present this way. Any new epigastric pain radiating to the back should be assessed by a clinician the same day.
When to See a Doctor
Book a GP appointment if your epigastric pain persists for more than a week, if you have unexplained weight loss, difficulty swallowing, persistent nausea, or black tarry stools. For persistent symptoms, an endoscopy at The Vesey can provide a definitive diagnosis.
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The Vesey Private Hospital, Sutton Coldfield · Open 7 days · 8am–8pm · 0121 387 3727