Pains in the epigastrium – the main causes. When to see a doctor?

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Pains in the epigastrium can have various causes – both from the gastrointestinal tract and unrelated to it. Most often they are described as pain in the area of ​​the navel or above the navel. There are several very important organs in the epigastric region, such as the liver, pancreas and spleen. Abnormalities in these organs can cause pain.

What is epigastric pain?

Epigastric pain is a condition that is usually located in the upper part of the abdomen (above the navel). The upper abdomen is the upper and middle area of ​​the abdomen, along with the right and left hypochondrium. In the area of ​​the bulwark there are organs important for humans, including the stomach, pancreas, duodenum and spleen. Epigastric pain most often indicates digestive system ailments, although not always. Sometimes it also affects the muscles of the epigastric region or irritation of the peritoneum. Sometimes the pain is a consequence of diabetes or ischemic heart disease.

Causes of epigastric pain

The causes of this ailment are very different, they can concern both the organs in the abdominal cavity and systemic diseases. The most common causes of epigastric pain are:

1. peptic ulcer disease (stomach and duodenum),
2. esophagitis
3. gastroesophageal reflux,
4. gallbladder stones (the pain is stabbing and is located in the right side under the ribs),
5. acute cholecystitis, inflammation of the bile ducts,
6. hepatic colic, acute hepatitis,
7. inflammation of the pancreas (acute or chronic) – described as severe pain in the middle of the abdomen, which often radiates to the back,
8. infarction, abscess, spleen rupture,
9. inflammatory bowel diseases,
10. acute intestinal ischemia,
11. occlusion,
12. appendicitis located in the cochlea,
13. subdiaphragmatic abscesses,
14. pyelonephritis, renal colic,
15. heartburn – characterized by a burning sensation in the esophagus and the reflux of stomach contents into the esophagus; sometimes there is a burning pain behind the breastbone and in the upper abdomen,
16. inflammation of the lower lobe of the right or left lung,
17. aortic aneurysm, heart attack
18. stomach cancer – it is characterized by pains that occur especially after eating a meal, but disappear when the patient is on an empty stomach. Antacids are of no use. Other symptoms include nausea, lack of appetite, gas, weakness, vomiting, and blood in the stools.

Abdominal pain and diabetes

Complications often develop in patients with type I or type II diabetes. Some diabetics also have autonomic neuropathy that damages the nerves responsible for controlling the digestive tract. The consequence of this damage may be gastroperaza, i.e. a very slow gastric emptying, characterized by nausea and vomiting. In addition, patients report epigastric pain and flatulence accompanied by a lack of appetite in the doctor’s office. When vomiting, undigested food that has been eaten several hours before is returned.

Epigastric pain and ischemic heart disease

Myocardial ischemia is caused by changes in the coronary arteries that transport blood to the heart. Coronary artery disease is characterized by chest pain or, nonspecifically, epigastric pain. It usually occurs after eating a meal or under the influence of stress and exercise.

Shingles in epigastric pain

People with developing shingles experience pain in the muscles, throat and head at first, making it seem like a common cold. However, over time, neurological pains begin to build up, and are usually located on one side of the body or face (depending on the type of nerve affected). Often pain ailments affect the area of ​​the back, waist and upper abdomen.

Sick thyroid gland and epigastric pain

Contrary to appearances, the cause of epigastric pain may also be thyroid disease (hypothyroidism). The symptoms include constant feeling of cold (despite the heat), drowsiness, constipation, the formation of a “second chin”, depressive thoughts, malaise and hair loss in the armpits.

Abdominal pain and pneumonia

It accompanies pneumonia (especially lower lobe inflammation). Characteristic for this ailment is the occurrence of cough, shortness of breath and pain in the chest. At first, the symptoms are quite inconspicuous, as they resemble standard flu: general breakdown, fever, chills. People with lower lobe pneumonia may experience upper abdominal pain.

Upper abdominal pain after a heart attack

Pains in the epigastrium form the so-called heart attack abdominal mask. In short, these are non-specific symptoms of a heart attack, including upper abdominal pain (usually in the right hypochondrium), nausea and vomiting, and general weakness. These types of symptoms suggest an infarction of the lower wall of the heart, which is adjacent to the abdominal cavity and the organs located in it. Then the pain may also apply to these areas and be associated with other ailments characteristic of diseases of the digestive system.

Diagnostics of epigastric pain

In diagnostics, it is important to differentiate epigastric pain as it helps to find the cause of the ailments. A thorough medical history with the patient and tests are necessary. In general, epigastric pain is divided into acute and chronic, so describe to the doctor what pain I feel: stinging, dull, squeezing or distressing? Its location is also important, e.g. right hypochondrium, left hypochondrium, middle epigastrium, pain radiating to the back. Another equally important factor is determining whether the pain occurs after eating or whether it also occurs on an empty stomach and during sleep. You should inform your doctor about co-occurring symptoms, e.g. heartburn, nausea, constipation, high temperature or problems with swallowing food, and about the preparations you are taking.

The basic examination performed in patients with epigastric pain is a physical examination, which includes both an abdominal examination and an assessment of the general condition of the patient. The abdomen is made by a doctor:

1. palpated – painfulness under pressure is checked; palpation allows the detection of a tumor or ascites,
2. auscultated – thanks to which it is possible to assess the patient’s intestinal peristalsis,
3. viewed – diagnosis of a possible hernia,
4. tapped – to assess the sounds coming from above the abdominal cavity.

In addition, the specialist examines symptoms such as:

1. Goldflam’s symptom – when hitting the back area in the projection of the kidneys, there is pain that indicates kidney stones or acute pyelonephritis,
2. Chełmoński symptom – pain occurs when the right costal arch is hit, which may suggest inflammation of the gallbladder,
3. Blumberg symptom – as a rule, its positive character indicates peritonitis.

Depending on the medical history and the results of the physical examination, the doctor may recommend basic laboratory tests, e.g. glucose concentration, peripheral blood counts, liver tests or an ionogram and the activity of transaminases. It is also useful to have a urine test that will reveal any urinary tract infections and a stool test to rule out the presence of parasitic ailments.

abdominal ultrasound is performed to visualize kidney stones and stones in the gallbladder. When gastroesophageal reflux or gastric and duodenal ulcer disease is suspected, it is performed gastroduodenoscopywhich enables the detection of Helicobacter pylori infection. ECG examination is performed when epigastric pain is related to cardiological complaints.

Epigastric pain – when to see a doctor?

Urgent inpatient intervention is epigastric pain caused by acute cholecystitis, pancreatitis, myocardial infarction or complications following peptic ulcer disease. Then, cardiological or surgical assistance is necessary, which often saves patients’ lives.

Abdominal pains, which are accompanied by a general deterioration of the patient’s condition, as well as increased heart rate, high temperature and sweating – are also an indication for immediate consultation with a specialist. A very large amount of epigastric pain may be shocking, for example appendicitis or acute pancreatitis. Upper gastrointestinal bleeding is suspected if patients have coexisting bloody vomiting and melaena.