From the Guidelines
Yes, pain can be referred from the epigastrium to the underarm area, and this phenomenon is attributed to shared nerve pathways between the upper abdomen and the axillary region. Conditions like acid reflux, gastritis, pancreatitis, or gallbladder disease that cause epigastric pain can sometimes manifest as pain radiating to the armpit, as sensory nerves from these areas converge at similar levels in the spinal cord, causing the brain to misinterpret the origin of the pain signals 1.
Key Considerations
- The British Society of Gastroenterology guidelines on the management of functional dyspepsia highlight the importance of understanding the complex relationship between the upper gut and the brain in the perception of pain 1.
- Diagnostic criteria for epigastric pain syndrome (EPS) include bothersome epigastric pain or burning that impacts usual activities at least one day a week 1.
- It is crucial to seek medical evaluation for persistent pain in both the epigastric and underarm areas to determine if the pain represents referred pain from a gastrointestinal issue or indicates a separate problem 1.
Clinical Implications
- A healthcare provider can determine the underlying cause of the pain through a comprehensive evaluation, including the timing, quality, and triggers of the pain.
- Treatment will depend on the underlying cause rather than just addressing the pain symptoms, and may involve medications, lifestyle changes, or further investigation to rule out serious causes 1.
- The management of functional dyspepsia, which can include epigastric pain, involves a multidisciplinary approach, considering the patient's perspective and the latest evidence-based recommendations 1.
From the Research
Referred Pain from the Epigastrum
The question of whether pain can be referred from the epigastrum to under the arm pit is an interesting one.
- There are no direct studies in the provided evidence that discuss referred pain from the epigastrum to the arm pit.
- However, the provided studies discuss gastroesophageal reflux disease (GERD) and its management options, including proton pump inhibitors (PPIs) and endoscopic therapies 2, 3, 4, 5, 6.
- These studies focus on the diagnosis and treatment of GERD, but do not address the specific topic of referred pain from the epigastrum to the arm pit.
- It is possible that the pain under the arm pit could be related to other conditions, such as musculoskeletal or neurological issues, but this is not discussed in the provided evidence.
Limitations of the Evidence
- The provided studies are limited to the topic of GERD and its management, and do not provide information on referred pain from the epigastrum to the arm pit.
- Further research would be needed to determine if there is a connection between the epigastrum and referred pain under the arm pit.