Gastroesophageal Reflux Disease (GERD): This is often the most common cause of epigastric pain due to the reflux of stomach acid into the esophagus, leading to inflammation and pain.

Peptic Ulcer Disease: Both gastric and duodenal ulcers can cause epigastric pain, typically described as burning or gnawing, and can be related to food intake.
Gastritis: Inflammation of the stomach lining can cause epigastric pain, nausea, and vomiting, often related to alcohol use, NSAIDs, or stress.
Functional Dyspepsia: A condition characterized by recurring epigastric pain or discomfort not explained by other pathologic conditions, often related to eating.

Myocardial Infarction: Although chest pain is the classic symptom, myocardial infarction can sometimes present with epigastric pain, especially in women, diabetics, or the elderly.
Pancreatitis: Both acute and chronic pancreatitis can cause severe epigastric pain radiating to the back, often associated with nausea, vomiting, and elevated pancreatic enzymes.
Cholecystitis: Inflammation of the gallbladder can cause right upper quadrant pain but can sometimes be perceived as epigastric, especially if the gallbladder is inflamed and distended.
Esophageal Rupture or Perforation: A medical emergency that can present with severe epigastric or chest pain, often following forceful vomiting or an endoscopic procedure.

Gastric Cancer: Although rare, gastric cancer can present with epigastric pain, weight loss, and difficulty swallowing, more common in certain geographic areas or with a family history.
Zollinger-Ellison Syndrome: A rare condition characterized by excessive gastric acid production due to a gastrin-secreting tumor, leading to severe peptic ulcers and epigastric pain.
Eosinophilic Esophagitis or Gastritis: Rare conditions characterized by eosinophilic infiltration of the esophagus or stomach, often presenting with dysphagia, food impaction, or epigastric pain, especially in patients with atopic diseases.