Epigastric Pain

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What is epigastric pain?

Epigastric pain is pain that is localized to the region of the upper abdomen immediately below the ribs. Often, those who experience this type of pain feel it during or right after eating or if they lie down too soon after eating. It is a common symptom of gastroesophageal reflux disease (GERD) or heartburn. It may be associated with the gastric contents moving upward into the back of the throat, causing inflammation and a burning pain.

Epigastric pain may also occur with conditions that cause inflammation of the digestive organs, such as gastritis and pancreatitis. Pregnant women may experience epigastric pain due to increased abdominal pressure and hormonal changes that slow the digestive process. Epigastric pain can also arise from conditions that impair the normal digestive process, such as peptic ulcers, hiatal hernias, or gallstones. In these cases, it may occur frequently after meals, and it may become chronic.

Some people have mild epigastric pain that occurs after eating and subsides quickly, while others may have a severe burning feeling in the abdomen, chest and neck that prevents sleep. Other symptoms that may accompany epigastric pain include abdominal bloating, constipation, diarrhea, and vomiting, depending on the underlying cause. In rare cases, epigastric pain is due to heart conditions such as heart attack and angina (chest pain due to the heart not getting enough oxygen).

Epigastric pain is not a serious symptom on its own. However, if it occurs with other life-threatening symptoms, it may be a sign of a condition that should receive immediate medical treatment, such as a heart attack. Seek immediate medical care (call 911) if you, or someone you are with, experience epigastric pain along with life-threatening symptoms such as severe breathing problems; chest pain, pressure or tightness; or vomiting blood or black material.

Seek prompt medical care if you are being treated for epigastric pain but mild symptoms recur or are persistent.

What other symptoms might occur with epigastric pain?

Epigastric pain may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Frequently, symptoms that affect the digestive tract may also involve other body systems.

Gastrointestinal symptoms that may occur along with epigastric pain

Epigastric pain may accompany other symptoms affecting the digestive system such as:

In some cases, symptoms of epigastric pain can be a sign of a heart attack or serious condition. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

What causes epigastric pain?

Epigastric pain has many possible causes. Most commonly, epigastric pain is the result of overeating, drinking alcohol while eating, or consuming greasy or spicy foods. Epigastric pain can be caused by digestive conditions such as acid reflux or lactose intolerance. Gastroesophageal reflux disease (GERD) is another possible cause of epigastric pain. Inflammatory diseases or cancers affecting the gallbladder, pancreas or stomach may result in epigastric pain. Pain in the epigastric region can also be a sign of a cardiovascular problem such as a heart attack or angina (chest pain due to the heart not getting enough oxygen).

Common causes of epigastric pain

Epigastric pain can be due to common causes including:

  • Dyspepsia (indigestion)

  • Gastritis (inflammation of the stomach lining)

  • Gastroesophageal reflux disease (GERD), a condition in which acidic stomach contents flow back into the esophagus

  • Heartburn

  • Lactose intolerance

  • Pregnancy

  • Side effects to medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs)

Other causes of epigastric pain

Epigastric pain may have other causes including:

  • Barrett’s esophagus (cellular changes in the esophagus that may lead to esophageal cancer)

  • Esophagitis (inflammation of the esophagus)

  • Gallstones or gallbladder disease

  • Hiatal hernia (protrusion of the stomach into the chest through a hole in the diaphragm)

  • Pancreatic cancer

  • Pancreatitis (inflammation of the pancreas)

  • Peptic ulcer or perforated peptic ulcer, resulting in stomach bleeding or an intestinal ulcer

  • Stomach or esophageal cancer

Serious or life-threatening causes of epigastric pain

In some cases, epigastric pain may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

  • Angina (chest pain due to the heart not getting enough oxygen)

  • Heart attack (myocardial infarction)

Questions for diagnosing the cause of epigastric pain

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your epigastric pain including:

  • How long have you felt epigastric pain?

  • Are there certain times your epigastric pain is more severe?

  • Are you lactose intolerant?

  • Do you have angina or any other heart problems?

  • Do you have any other symptoms?

  • What medications are you taking?

  • Where precisely do you feel the pain?

What are the potential complications of epigastric pain?

Typically, epigastric pain on its own does not lead to serious complications. However, it can affect your quality of life by causing distress and discomfort when you eat. This may change your eating patterns and result in unintentional weight loss. Further, epigastric pain can mimic serious heart symptoms. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of epigastric pain include:

  • Cancer of the esophagus, stomach, or other organs

  • Esophageal scarring and narrowing

  • Myocardial infarction (heart attack), if the pain is due to angina

  • Poor nutrition due to a decreased desire to eat

  • Poor quality of life|

  • Spread of cancer

  • Spread of infection

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 10
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Indigestion. National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/indigestion/.
  2. Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) in Adults. National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/.