From the Guidelines
Epigastric pain is most commonly caused by gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), gastritis, duodenal ulcer disease, myocardial infarction, pancreatitis, acute aortic syndromes, gastric cancer, and hiatal hernia.
Common Causes of Epigastric Pain
- Gastrointestinal disorders: GERD, PUD, gastritis, duodenal ulcer disease, gastric cancer, and hiatal hernia are common causes of epigastric pain, often accompanied by symptoms such as heartburn, regurgitation, dysphagia, nausea, vomiting, and hematemesis 1.
- Cardiovascular disorders: Myocardial infarction and acute aortic syndromes can also cause epigastric pain, especially when accompanied by symptoms such as shortness of breath, pain radiating to the back, and other cardiovascular risk factors 1.
- Pancreatic disorders: Pancreatitis is another potential cause of epigastric pain, often presenting with upper abdominal pain, vomiting, and features of epigastric or diffuse abdominal tenderness 1.
Diagnostic Considerations
The diagnosis of epigastric pain can be challenging due to overlapping symptoms between different conditions. Imaging studies, such as CT scans and fluoroscopy, can be useful in evaluating patients with epigastric pain, especially when the diagnosis is unclear or when complications are suspected 1.
Key Findings
- CT scans can show morphological changes in the gastroesophageal junction, gastric or duodenal wall thickening, mucosal hyperenhancement, and fat stranding due to inflammation, which can suggest a diagnosis of GERD, PUD, or gastritis 1.
- Fluoroscopy can be used to evaluate patients with epigastric pain due to reflux symptoms, esophagitis, or nonspecific abdominal pain, and can help detect inflammatory or neoplastic diseases, hiatal hernias, and lower esophageal rings or strictures 1.
From the Research
Causes of Epigastric Pain
The causes of epigastric pain can be diverse and include various gastrointestinal and extra-abdominal disorders. Some of the common causes of epigastric pain are:
- Gastroesophageal reflux disease (GERD) 2
- Duodenal ulcers, which tend to cause abdominal pain localized in the epigastric region, often at night, and can be alleviated by eating 2
- Gastric ulcers, which cause pain immediately after eating, and consuming food can increase the pain 2
- Irritable bowel syndrome, where abdominal pain is related to defecation 2
- Chronic pancreatitis, characterized by pain that radiates to the back 2
- Crohn's disease, where inflammation causes pain 2
- Acute non-traumatic epigastric pain, which can be caused by diseases of the stomach, duodenum, liver, pancreas, and biliary tree 3
- Ruptured sinus of Valsalva aneurysm, a rare but life-threatening cause of epigastric pain 4
Gastrointestinal Causes
Gastrointestinal causes of epigastric pain can be further divided into:
- Ulcer-like dyspepsia, characterized by predominant pain centered in the upper abdomen 5
- Dysmotility-like dyspepsia, characterized by discomfort 5
- Peptic ulcer disease and gastritis, which can cause epigastric pain and have associated complications 6
- Acute pancreatitis and esophageal emergencies, which are serious intra-abdominal causes of epigastric pain 6
Diagnostic Approach
The diagnostic approach to epigastric pain involves a combination of clinical evaluation, laboratory testing, and imaging studies. Clinical bedside ultrasonography (US) is a useful tool in the diagnosis of acute epigastric pain, as it is rapid, non-invasive, and relatively inexpensive 3. Advanced imaging, such as computed tomography, may also be necessary in some cases 6. A systematic approach to the diagnosis of epigastric pain, including consideration of cardiac and intra-abdominal causes, is essential to ensure accurate diagnosis and effective management 6.