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Epigastric pain

Epigastric pain is a bothersome condition of the abdomen, which has numerous underlying causes that are more serious than regular digestive problems. Read and know more about the types, causes, symptoms, diagnosis and treatment of this disorder.

Epigastric pain Definition

This condition is manifested by gnawing pain in the epigastrium or epigastric region – the upper central region of the abdomen above the umbilicus or belly button. It is not an independent disorder, but a symptom common to a wide range of ailments. Chronic epigastric pain develops when a mild ache gradually transforms into a severe pain.

The condition is also known by other names like:
Picture of Epigastric pain

Picture 1 – Epigastric pain

  • Epigastric Pain Syndrome
  • Mid epigastric pain

Epigastric pain ICD 9 Code

The ICD 9 code for this disorder is 789.06.

Epigastric pain Types

This pain has a tendency to radiate in several directions. It is normally differentiated into the following types:

  • Right epigastric pain
  • Left epigastric pain
  • Lower epigastric pain

Epigastric pain Symptoms

Patients affected by this disease frequently complain of a burning pain in the upper abdomen. This abdominal pain generally occurs after a meal. Hence, it is sometimes called Postprandial Epigastric Pain. The esophagus may also be subjected to acute discomfort and inflammation.

Mild upper left pain normally subsides after a while. In most cases, however, severe pain can develop in the abdomen, chest and neck and is usually intermittent. The gastrointestinal pain is also associated with a piercing sharp pain that radiates to the back. The condition causes severe back pain that worsens at night and disrupts sleep. The other symptoms include:

  • Constipation
  • Diarrhea
  • Nausea
  • Abdominal bloating
  • Upper chest pain
  • Flatulence
  • Burping
  • Pain radiating down the shoulders and arms
  • Shortness of breath

Epigastric pain Causes

The condition can be linked to a number of gastrointestinal disorders like:

Gastritis

It is an inflammation or irritation of the abdominal lining that leads to a burning or gnawing sensation or dull pain in the upper central abdominal section.

Indigestion

This upper abdominal pain can also develop during an abnormal or impaired digestion. The mucosa or protective lining of the digestive system may come in contact with the acidic contents of the stomach, causing a burning sensation.

Gastroesophageal reflux disease (GERD)

It is a condition marked by regurgitation of acidified liquid content into the esophagus. This results in acute pain in the epigastric region that is symptomatic of esophageal inflammation and damage.

Peptic ulcer disorder

In this condition, the inner lining of the abdomen, duodenum and esophagus is corroded by acidic digestive juices which are secreted by the stomach cells. The inflammatory reaction that generates as a consequence of ulceration gives rise to sharp pain in the upper abdomen.

Gallstones

These are hard, pebble-like deposits that form inside the gall bladder that leads to constant pain in the upper and lower region of the abdomen.

Pancreatitis

It is an inflammatory condition of the pancreas. The problem occurs when the pancreatic enzymes responsible for digestion of food get activated in the pancreas instead of the small intestine. Severe upper abdominal pain radiating to the back is the most common characteristic of this disorder.

Malabsorption

It is an abnormality in the digestive system that creates difficulty in absorbing essential nutrients from food, causing various abdominal problems, including pain in the epigastrium.

Intestinal ischaemia

Gastrointestinal pain can also occur when decreased blood flow to the intestine causes its irreversible destruction.

Hiatus hernia

It is sometimes denoted as “Epigastric hernia” where a section of the stomach protrudes through the diaphragm and up into the chest. The formation of hernia interferes with the esophageal sphincter, producing symptoms of GERD.

Gastric volvulus

The condition is characterized by twisting of the stomach upon itself, causing severe abdominal pain, mainly in the central upper abdomen.

Gastric lymphoma

It is a form of lymphoma that originates in the stomach and is normally a cancer of the lymphocytes – a group of cells that is an essential part of the immune system.

Sandifer syndrome

The pediatric neurological disorder has associated symptoms like vomiting, poor feeding, and epigastric discomfort.

Helicobacter pylori bacteria

Helicobacter pylori infection can cause abdominal infection accompanied by acute gastritis and pain.

Zollinger Ellison syndrome

It is a complicated condition in which one or more tumors develop in the pancreas, duodenum, as well as in the adjacent lymph nodes. These tumors secrete a large amount of the hormone Gastrin that stimulates the stomach to produce excessive acid, causing heartburn.

Lactose intolerance

It is the inability to digest and absorb lactose which gives rise to a variety of digestive problems when any form of milk product is consumed.

Pregnancy is another cause of pain in the epigastrium where increased abdominal pressure and hormonal changes slow the digestive process. The other possible causes may include:

  • Myocardial ischemia
  • Myocardial infraction
  • Pneumonia
  • Hiatus hernia
  • Celiac artery stenosis
  • Copper toxicity
  • Pylephlebitis
  • Diabetes

Epigastric pain in children

The condition is more prevalent in young children, owing to several reasons like:

  • Food poisoning
  • Medical causes
  • Gastrointestinal infections

Epigastric pain Diagnosis

Experienced healthcare professionals begin the diagnosis of the condition by asking a set of questions to affected patients to know the exact cause of the pain. These generally include:

  • The location of the pain
  • The duration of the pain
  • The frequency of the pain
  • The severity of the pain
  • Presence of any additional symptoms
  • Presence of any sort of cardiac abnormality

A few tests and exams are conducted to detect the various disorders that are associated with the upper central abdominal pain. The commonly used techniques are:

X-ray

Upper gastrointestinal x-ray can determine the cause of the persistent pain. Distended stomach, hiatal hernia as well as disorders of the pancreas, duodenum and esophagus are clearly visible.

Endoscopy/ Gastroscopy

In this non-invasive technique, an endoscope is inserted via mouth into the upper gastrointestinal tract comprising of the esophagus, stomach and duodenum. The test facilitates detection of any tumor or ulcer in the tract.

Imaging studies

In many cases, an abdominal computed-tomography (CT) scan, magnetic-resonance imaging (MRI) or ultrasound examination are generally very useful for discovering the origin of the pain.

Cardiac test

If the pain is not related to any digestive ailments, healthcare providers usually go for a cardiac evaluation to diagnose conditions like angina or myocardial infarction by using some common heart tests.

Epigastric pain Differential Diagnosis

The following disorders are considered during the differential diagnosis of the condition:

  • Mesenteric hemorrhage
  • Slipping rib syndrome
  • Aortic dissection
  • Liver hemorrhage

Epigastric pain Treatment

Elevated levels of acids in the stomach need to be normalized by using the following prescribed drugs:

Image of Epigastric pain

Region of Epigastric pain in Humans

Picture 2 - Epigastric pain Image

Antacids

Minor upper abdominal pain can be reduced with the intake of antacids. These are available in either liquid or tablet form, which easily dissolves in water. This class of drugs comprises mainly of sodium bicarbonate that neutralizes the stomach acids and prevent the symptoms of an acid reflux or ulcer.

Ibuprofen

It belongs to a class of non-steroidal anti-inflammatory drugs (NSAIDs) that dissolves in the small intestine and covers the inner lining with an analgesic. This is highly beneficial in ceasing the epigastric inflammation and the associated pain.

Cimetidine

The drug falls under the category of histamine H2-antagonists that inhibit the action of histamine on the acid-producing stomach cells. It delays the process of gastric acid production and relieves the patients from the constant burning pain. Duodenal ulcers, gastric ulcer and GERD are treatable using this medication.

Ranitidine

It is an oral drug that blocks the production of stomach acid and is a popularly used histamine2 blocker. It is available in the form of Zantac and Tritec.

Epigastric pain is not a life-threatening condition and can be controlled by taking correct dose of the prescribed drugs. Proper care of the abdomen is particularly crucial for individuals who are above the age of 40 as they are more vulnerable to this pain.

References:

http://www.patient.co.uk/doctor/Epigastric-Pain.htm

http://www.localhealth.com/article/epigastric-pain

http://epigastricpain.net/

http://www.abdopain.com/upper-central-abdominal-pain.html

By   Last updated August 29th, 2012

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