The epigastric region is where the following major structures/organs are located: stomach, pancreas, duodenum and a part of liver in addition to muscles, peritoneum and fascia. When investigating pain located to this area, we think of disturbances in these organs/structures, or pain referred to this are from other distant diseased organs.
The characteristics of epigastric pain help in pinning down its origin/underlying cause:
-relation to meals: before meals (on empty stomach or when hungry, during, or after?
- Nature: dull, burning, stabbing, colicky
- Radiation: to the arms and shoulders, neck, back
- What improves it or worsens it (like food, or defecation)
- Associated symptoms: like nausea/vomiting, belching etc
You get a burning sensation in the chest as a result of high gastric acid secretions that travel up back to the esophagus and results in pain behind the sternum (chest bone) as well as in the epigastrium.
Gastrointestinal reflux disease
Gastroesophageal reflux disease (GERD), in which there is regurgitation of food from the stomach back to the esophagus, produces a burning sensation behind the sternum, associated with nausea and a feeling of stickiness of food behind the chest. It is basically due to a defect in the muscle that connects the esophagus to the opening of the stomach (the upper esophageal sphincter) that makes it unable to close properly and thus it fails to prevent the digested food from going backwards into the esophagus. The pain of GERD gets worse on lying down flat on the back or, bending.
Diseases of the Stomach
Inflammation of the wall of the stomach, pain accompanied by nausea and weight loss (because pain induces stopping or even avoiding food intake)
2. Peptic and Duodenal Ulcer
These are the most common causes of the epigastric pain. The most common etiology of ulcer is Helicobacter pylori infection (a type of bacteria). In case of peptic ulcer, epigastric pain is worse on an empty stomach and improves upon eating. In addition to epigastric pain, there are symptoms of waterbrash, bloating, abdominal fullness, and sometimes hematemesis (vomiting that has blood in it, indicating that the ulcer is oozing blood). Duodenal ulcer, on the other hand, causes pain that is aggravated by food intake few hours after the meal.
Due to inflammation or infection of the stomach and the intestine. The main symptoms are abdominal pain, fever, nausea and diarrhea.
Gastric Carcinoma (least likely)
Abdominal pain, unintentional but also weight loss
Disorders of Pancreas
Pancreatitis (inflammation or infection of the pancreas)can be acute or chronic. Acute pancreatic occurs with a severe pain that radiates towards back and that is relieved by bending forward. Chronic is characterized by mild pain in the epigastrium. It can occur after a viral illness, or in chronic alcoholics.
Pancreatic cancer is much less likely.
Gallbladder Causing Disease
Gallbladder stones or gallbladder’s inflammation usually produce pain in the right abdominal region that also radiates to the epigastric area. The pain is usually gnawing and is associated with nausea/vomiting (usually vomiting bile) and anorexia.
Hepatitis most commonly due to a viral infection (in our part of the world, Hepatitis A and EBV viruses are quite common causes of hepatitis). Hepatitis is characterized by yellow discoloration of the skin and sclera (the white of the eye), fever, loss of appetite, nausea.
Other less likely causes: hiatal hernia (part of the stomach protrudes up through a diaphragm tear); appendicitis (pain usually starts in the stomach are then locates to the right lower part of the abdomen, radiates to the right leg, and is associated with fever, nausea and vomiting)
You need to be fully evaluated by a physician who will look for clues in the history of your symptoms, examine you, order blood tests (like a complete blood count to look for signs of infection or anemia due to blood loss, maybe an ultrasound or scope etc) and try to determine the exact cause of the pain and prescribe the proper treatment.