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What causes epigastric pain?

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What epigastric pain indicatesPain radiating to the backCause of epigastric painWhen is it an emergency?TreatmentSummary
Epigastric pain refers to discomfort and aches in your upper abdomen. Causes may include acid reflux, hernias, or pancreatitis. In some cases, prompt medical attention is required.
Medically reviewed by Cynthia Taylor Chavoustie, MPAS, PA-C
Updated on

Epigastric comes from ”epi,” meaning upon, and ”gastric,” meaning having to do with the stomach. Epigastric pain is localized in the upper abdomen, below your ribs.

This article will review the potential causes of epigastric pain, common related symptoms, and when to seek medical assistance.

What does epigastric pain indicate?

Young woman experiencing epigastric pain
Photography by Milan2099/Getty Images

Epigastric pain may be a symptom of different conditions. Some of them may be temporary, and others may require medical assistance. Identifying other symptoms may help you determine what steps to follow.

Indigestion and overeating

When you eat, your stomach produces acid to help with food digestion. This gastric acid may irritate the lining of the digestive system and cause epigastric pain.

Eating large quantities of food in little time may also trigger indigestion and epigastric pain.

If you have indigestion, you may also experience:

  • nausea
  • bloating
  • overall discomfort
  • belching or passing gas

Indigestion may resolve on its own or with the help of over-the-counter digestive aids.

Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD)

GER is what some people commonly refer to as heartburn. It happens when food, liquid, or acid from your stomach comes back up your esophagus. It may cause you to experience acid reflux.

Heartburn often comes with pain in the chest or upper abdomen. It may happen once in a while when you eat something spicy or extremely seasoned. But for some people, it may be an everyday occurrence.

When you experience GER often, it may lead to additional symptoms and complications, like GERD.

Common symptoms of GER and GERD include:

  • nausea
  • regurgitation
  • difficulty or pain when swallowing
  • burning sensation in the esophagus
  • intense pain in the upper abdomen or higher

Both GER and GERD are manageable, and relief is possible.

Lactose intolerance

Lactose intolerance may cause epigastric pain when your body cannot break down dairy proteins.

Other symptoms of lactose intolerance may include:

  • nausea and vomiting
  • diarrhea
  • abdominal cramps
  • passing gas

Lactose intolerance is typically managed by avoiding dairy.

Peptic ulcer disease

Peptic ulcers may occur when an infection, eating habits, or medications cause sores on the lining of your stomach or small intestine. Peptic ulcers can cause epigastric pain and, in some cases, internal bleeding.

Other symptoms of peptic ulcers may also include:

  • nausea and vomiting
  • bloating
  • blood in your stools
  • blood in your vomit


Gastritis is the chronic inflammation of your stomach lining.

Bacterial infections, medications, and high stress levels may lead to the onset of gastritis.

Besides epigastric pain, other symptoms of gastritis may include:

  • nausea and vomiting
  • feeling bloated
  • loss of appetite
  • belching and passing gas

Hiatal hernia

Hiatal hernia is when a portion of the stomach moves up into the chest through your breathing muscle, also known as your diaphragm. You may live with a hiatal hernia and experience few to no symptoms. However, epigastric pain is quite common, especially when lying down.

Other symptoms of a hiatal hernia may include:

  • halitosis (bad breath)
  • bloating
  • nausea and vomiting
  • acid reflux and heartburn after eating
  • difficulty or pain when swallowing

Gallbladder disorder

Conditions related to your gallbladder may cause intense epigastric pain. Organ inflammation or the presence of gallstones may be the cause of the pain.

Other symptoms of gallbladder problems, including stones, may include:

  • nausea and vomiting bile (yellow fluid)
  • fever
  • chills
  • jaundice (yellowing of the skin and eyes)
  • changes in the color of your urine and stools

Some gallbladder conditions may become medical emergencies. It is highly advisable that you seek medical assistance if you experience severe epigastric pain, fever, and referred pain, among other symptoms.

Alcohol-related irritation

Drinking alcohol, particularly without eating first, can overwhelm the gastrointestinal system and cause inflammation in the lining of the stomach. This may also cause epigastric pain, similar to that experienced in gastritis.

Epigastric pain radiating to the back

If you experience epigastric pain that radiates to the left side of the upper abdomen and you experience nausea and vomiting, you may have acute pancreatitis. It is highly advisable that you receive medical attention as soon as you can.

Acute pancreatitis refers to inflammation of your pancreas, a large gland behind your stomach that produces hormones and digestive juices.

Symptoms of acute pancreatitis may include:

  • nausea and vomiting
  • high temperature of 38°C (100.4°F) or above
  • palpable swelling in the abdomen
  • bloating
  • indigestion symptoms
  • fast heartbeat (tachycardia)
  • jaundice (yellowing of the skin and eyes)
  • rapid breathing rate
  • radiating pain to the left side or the back

Finding the cause of epigastric pain

Severe epigastric pain or pain that lasts for more than an hour and is accompanied by other symptoms may require a visit to a health professional.

Your health team may gather more information about your symptoms and medical history and recommend a combination of tests, including:

  • complete laboratory tests to check liver enzymes, inflammation markers, blood count, and thyroid hormones
  • breath or stool tests for bacterial overgrowth and infections like H. pylori
  • ultrasounds of the abdomen area
  • CT scan
  • upper endoscopy
  • urine tests
  • electrocardiogram (ECG)

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When is epigastric pain an emergency?

Epigastric pain may indicate a medical emergency if you experience a combination of the following:

  • severe or very sudden pain that does not subside
  • increased pain when you touch your stomach
  • blood in your vomit
  • blood in your poo
  • vomiting
  • chest pain
  • inability to urinate
  • inability to poo or pass gas
  • difficulty breathing
  • dizziness
  • fainting

How to treat epigastric pain

The treatment for epigastric pain may vary depending on the root cause. Because it has many possible causes, your health team will aim to find the reasons behind your symptoms before prescribing a treatment plan.

If your pain does not subside, your health team may provide pain-relieving medications and anti-inflammatories while they decide on the next steps.


Epigastric pain refers to pain in the upper abdomen, below your rib cage. Causes may include indigestion, gastritis, or acid reflux. In some cases, like gallbladder disease and acute pancreatitis, the pain is considered a medical emergency.

Treatment of epigastric pain may depend on the root cause and the other symptoms you are experiencing.

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