What Can Cause Epigastric Pain Below the Ribs?

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C
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Epigastric pain is upper abdominal pain right below the ribs. “Epi” means “over” or “upon,” and “gastric” means “of the stomach.” However, the epigastrium also houses the pancreas and parts of the liver and small intestine. Oftentimes, those who experience this type of pain feel it during or right after eating or when they lie down too soon after eating. Epigastric pain is a common symptom of acid reflux and indigestion.

Epigastric pain may also occur with conditions that cause inflammation of the digestive organs, such as gastritis and pancreatitis. Pregnant people may experience epigastric pain due to increased abdominal pressure and hormonal changes that slow digestion.

Keep reading to learn more about common causes of epigastric pain and what to do about them.

What causes epigastric pain? What should I do?

Unseen person standing outdoors with hands crossed over stomach
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Epigastric pain, or upper abdominal pain, has many possible causes. Epigastric pain is often the result of overeating, drinking alcohol while eating, or consuming greasy or spicy foods.

Epigastric pain can be the result of digestive conditions, such as acid reflux, peptic ulcer disease, or lactose intolerance. Gastroesophageal reflux disease (GERD) is another possible cause of epigastric pain.

Inflammatory diseases or cancers affecting the gallbladder, pancreas, first part of the small intestine, or stomach may result in epigastric pain.

Pain in the epigastrium, or upper abdomen, can also be a sign of a cardiovascular problem, such as a heart attack or angina. Epigastric pain may radiate to the back, shoulder, or arm.

Indigestion

Your body produces acid to digest the food you eat. Sometimes, there is an imbalance in this acid, and it can burn or irritate the lining of your stomach. This can cause pain in or just above your stomach, which is epigastric pain.

If you have indigestion, you may also notice:

  • frequent burping
  • a feeling of being bloated
  • nausea

If you experience indigestion, you may be intolerant to something you have just eaten. Try keeping a food diary to discover whether certain foods or food types are causing a pattern of making you feel epigastric pain when you eat them.

Learn when to contact a doctor for indigestion.

Gastritis

Gastritis refers to irritation of the stomach lining. It can cause abdominal epigastric pain. Gastritis can happen due to certain bacteria causing an overproduction of acid, but it can also be caused by an autoimmune condition.

Other symptoms of gastritis include:

Gastritis can cause ulcers to develop in your stomach lining. If you have symptoms of bleeding in your stomach, such as blood in your stool or vomit, you should seek medical attention right away.

Learn about acute gastritis here.

Gastroesophageal reflux

Sometimes, your stomach contents can rise back into your esophagus. This is known as gastroesophageal reflux, but some people know it as heartburn or acid reflux. You may notice a burning sensation in your chest and a bitter taste in your mouth as well as epigastric pain. Other symptoms include:

You can reduce some instances of gastroesophageal reflux with lifestyle changes. These can include:

  • maintaining a moderate weight
  • raising the head of your bed when you sleep
  • avoiding smoking
  • eating a balanced diet and avoiding trigger foods

However, if you find that you continue to experience reflux a few times a week for several weeks despite lifestyle changes, you may have GERD, which requires more medical attention.

Learn what doctors want you to know about acid reflux here.

Gastroesophageal reflux disease

GERD is a more severe and long-lasting condition than gastroesophageal reflux. GERD can lead to complications over time, including inflammation of the esophagus.

Doctors may still recommend lifestyle changes for GERD, but there are several medications that can also help to improve symptoms for people with the condition. These include:

  • Antacids: Mild GERD can benefit from over-the-counter (OTC) antacids. However, do not use these every day. There may be side effects.
  • H2 blockers: This type of medication can make your stomach produce less acid, which can then lessen the symptoms of GERD. Some are available OTC.
  • Proton pump inhibitors (PPIs): PPIs also lower the level of acid in your stomach. They can be more effective in treating GERD symptoms than H2 blockers in some cases. They can be especially useful for long-term treatment.
  • Other medicines: There may be other options if you are not able to take the above options. Discuss these with your doctor.

Learn more about treatment options for GERD here.

Lactose intolerance

According to experts, about 68% of the global population has difficulty absorbing lactose on some level. Lactose is a naturally occurring sugar that is found in dairy products like milk and cheese. If you are lactose intolerant, it means your small intestine cannot break down all the lactose you consume. It is not the same as being allergic to milk.

Learn 10 facts about lactose intolerance here.

Pregnancy

Pregnant people can experience epigastric pain due to a variety of causes, some of which do not involve the pregnancy at all. However, some causes involve the physiological, hormonal, respiratory, and circulatory changes the body goes through during pregnancy.

Contact a doctor if your pain becomes severe, you notice blood loss, or you are concerned in any way about your pain.

Learn more about when to go to the doctor when you are pregnant here.

Side effects of medications

Some medications can cause epigastric pain. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as:

  • ibuprofen
  • aspirin
  • naproxen

Other causes of epigastric pain

Epigastric pain may have other causes, including:

  • Barrett’s esophagus, which causes cellular changes in the esophagus that may lead to esophageal cancer
  • esophagitis, or inflammation of the esophagus
  • gallstones or gallbladder disease
  • hiatal hernia, which is the protrusion of the stomach into the chest through a hole in the diaphragm
  • cancer, such as pancreatic, stomach, or esophageal cancer
  • pancreatitis, or inflammation of the pancreas, in which epigastric pain may radiate to the back
  • peptic ulcer or perforated peptic ulcer, resulting in stomach bleeding or an intestinal ulcer

Urgent 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:

  • abdominal aortic aneurysm, in which epigastric pain may radiate to the back
  • angina, which is chest pain due to the heart not getting enough oxygen
  • heart attack

When should you contact a doctor for epigastric pain?

It is important to see a doctor for epigastric pain if it is severe, occurs suddenly, or is mild but lasts for more than a few days. You should also see a doctor if you experience epigastric pain frequently or it is impacting your quality of life.

Contact a doctor promptly if you have upper abdominal pain along with abdominal swelling or distention.

Although most cases are not serious, epigastric pain can be caused by life threatening conditions. Seek medical care right away or call 911 if epigastric pain occurs with any of these life threatening symptoms:

How might doctors diagnose epigastric pain?

If you see a healthcare professional for epigastric pain, they will review your symptoms and medical history. Along with an exam of your heart and lungs, the doctor will look at and feel your abdomen for possible abnormalities, bruising, masses, painful areas, and gas or fluid. Your clinician may also listen to your abdomen with a stethoscope for bowel sounds and blood flow through the aorta.

Preparing for your appointment

Questions for diagnosing the cause of epigastric pain

To diagnose your condition, your doctor or licensed healthcare clinician will ask you several questions related to your epigastric pain, including:

  • Where precisely do you feel the pain?
  • 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?

How is epigastric pain treated?

Epigastric pain treatment depends on the cause. Treatments may include home remedies, OTC and prescribed medications, and medical procedures or surgery.

For epigastric abdominal pain related to infection, a doctor will prescribe antibiotics if bacteria are the cause. Surgery or endoscopic procedures may be necessary for some causes of epigastric pain, such as hiatal hernia, esophagitis, gallbladder disease, and gastric ulcer.

Most cases of epigastric pain are related to the digestive system.

Home remedies for digestion-related causes of epigastric pain

For epigastric pain due to common conditions such as indigestion and acid reflux, you can try to:

  • Avoid carbonated drinks as well as coffee and alcohol.
  • Avoid spicy, greasy, and acidic foods. 
  • Drink water with baking soda (1 teaspoon for 8 ounces of water).
  • Drink ginger root steeped in hot water or tea (let cool slightly before drinking) for nausea.
  • Eat small, healthy meals several times a day.
  • Lie on your left side, which helps prevent reflux and helps you pass gas.
  • Rest with your upper body elevated, which helps prevent reflux.

Summary

Epigastric pain is not a serious symptom on its own. It is most commonly the result of indigestion or acid reflux. However, if it occurs with other life threatening symptoms, it may be a sign of a condition that should receive immediate medical treatment.

Seek immediate medical care if you or someone you are with experiences epigastric pain along with life threatening symptoms, such as severe breathing problems, chest pain, pressure or tightness, or vomiting blood or black material.

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Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2022 Apr 29
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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.
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