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Epigastric Pain - Location, Causes and Treatment

Location of Epigastric Pain


The Epigastrium or Epigastric region is the upper central portion of the abdomen. It is located between the costal arch (lower edge) of the thorax and the sub-costal plane.

Epigastric pain is subject to certain abnormal reactions that are associated with several diseases of Epigastrium. Pain occurs regularly when Epigastric region is defective. This defect can be marked by actions of the diaphragm. The rectus abdominus creates an outward protruding of the upper wall of the abdomen.

The sudden pain produces swift and forceful breath-exhalation. It brings with it a great sense of ineffectiveness and discomfort. In a nutshell, this pain can range from mild ache to severe pangs in the abdominal region.

Epigastric Pain Differential Diagnosis

There are quite a number diagnoses for Epigastric pain. However in younger adults this agonizing pain may be due to indigestion while in older people, acute vascular events can lead to such pain. It has been discovered that cancer produces pain which cannot be identified in two clock rotations except after great damage or occurrence of blockade. The below mentioned causes might be the manifestations of Epigastric pain.

  • Oesophageal Diseases: These disorders are common yet require medical advice if symptoms such as regurgitation, retro-sternal discomfort and heartburn occur. For acid-reflux, these include chest pain, adamant sore throat, hoarseness, chronic cough, swelling sensation in throat and asthma.
  • Gastric and Duodenal Ulcers: A chronic disease called peptic ulcer is characterized by ulcer formation in the duodenal wall.
  • Hepatobiliary Disorder: In this case, solid crystals are formed in the gall bladder that affects the bile duct, liver and bile fluid.
  • Pancreatitis: It is the inflammation of pancreas that in turn result is Epigastric pain.
  • Aortic/Cardiac Diseases: This pertains to chronic heart diseases or abnormalities in the esophageal region of the stomach.
  • Cystitis: It is a microbial infection found in the urinary bladder. In such-like cases, bacteria occur during sexual activity either by finding way into the bladder from the rectum or vagina. Symptoms such as urinating frequently, abdominal pain or pressure and pain throughout urination are common in cystitis.
  • Urethritis: This refers to the urethral lining infection. People with STD, gonorrhea, chlamydia, syphilis, AIDS, HIV, and herpes are more likely to possess such bacteria which once spread into the body can cause epigastric pain. Symptoms are chills, abdominal pain, abnormal vaginal discharge and fever.
  • Proteus Mirabilis: This bacterium lives naturally in human gastrointestinal tract which becomes pathogenic when enters into the lungs, unhealed wounds or urinary tract which resultantly causes epigastric pain.
  • Pelvic Inflammatory Disease: This refers to a uterus infection: fallopian tubes, ovaries or peritoneum. After the spread of bacteria, epigastric pain occurs followed by Nausea, fever, irregular menstrual cycle, pain through sexual intercourse, infertility and uterine bladder.
  • Diverticulitis: It is a common digestive disease that causes inflammation of the diverticulum which results in epigastric pain. Though occupied in all intestinal regions, it is commonly found in the lowest portion of the colon.

Epigastric Pain Examination

Expert and Professionals have conducted various examinations on patients in order to help them diagnose their condition by asking questions with the purpose to identify the exact cause of the epigastric pain. Modern technology has to be applied to detect the affected area in the body for optimum results. Following are some of the common techniques applied:


It is usually performed to assess possible disorders related to esophagus and stomach which evaluates symptoms of vomiting, abdominal pain, intestinal bleeding etc. Endoscopy has the ability to execute biopsies which detects abnormalities such as tumors, ulcers etc.


It executes tests on abdominal X-ray which shows the kidney, bladder, and ureter. It also shows the problems in the abdominal cavity like intestinal obstruction.


Urine of the patient is analyzed before the conduction of test by the doctor. This is to check the possibilities for urinary tract infection and affiliated disorders that may be followed by severe epigastric pain.

Blood tests

The doctor will ask for a blood sample from patient for CBC analysis including liver and pancreatic enzymes which will count the elevated enzymes as indicative for inflammatory infections.


This is done via abdominal ultrasound to assess internal organs which shows the result whether a patient has gall bladder disease, ovarian cyst, appendicitis or some other internal problem.

Imaging studies

Tests through CT scan, MRI are really useful to discover the origin of the pain.

Cardiac test

If epigastric pain is not related to any gastrointestinal ailment, cardiac evaluation is another resort for such assessment that may diagnose myocardial infraction through common heart examination. There are more diagnostic tests to be conducted to ascertain the causes of abdominal pain.

Treatment for Epigastric Pain

Treatment and medication varies from the result of diagnosis. The more severe diagnosis, the more complicated the treatment. Precautionary measures to relieve pain may be adopted before self-diagnosis.

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Following are the common prescribed drugs for normal Epigastric pain:

  • Cimetidine: It is usually prescribed in peptic ulcer and heartburn. It interrupts gastric acid production. Cimetidine is a Histamine H2-receptor antagonistused by patients for relief from recurring burning pains.
  • Antacids: It’s a substance that counterbalances stomach acidity. The drug sodium bicarbonate is mainly used to prevent ulcer or acid reflux.
  • Ranitidine: It is one of the histamine H2-receptor contenders that resist stomach acid production. It is commonly used for peptic ulcer patents and gastro-esophageal-reflex disease (GERD). Together with anti-histamines and fexofenadine, it can best treat skin disorders such as hives.
  • Ibuprofen: It belongs to a non-steroidal anti-inflammatory drug which usually plays a pivotal role in treating fever, swelling and pain. It has a mild anti-platelet effect and also acts as a vasoconstrictor.

Normal epigastric pain is not a life-threatening issue. It is just a mild pain usually treated with the right dosage of prescribed medicine. However, there are some complications which the patients may not be aware of. Therefore, it is best to seek medical advice from relevant physician/surgeon.


hambeleleni on September 10, 2014:

My self I m very suffering. Some time when I m paining ,I can't breathe and I also have so many saliva in my mouth, headache

Brijender singh on August 23, 2014:

Very good information helpful for me and persons suffering from epigestric disorder . Thank you.

Dr Rajesh (author) from India on June 26, 2014:

thank you all for the kind comments - I love to make content (medical content) easy for non medical people - because there are lot of health sites which use tough medical terms to explain and I will make sure that this wont happen in my articles ;) ...

Nelson Zungu on May 29, 2014:

Well presented, thank you

Happy Nkuba on May 04, 2014:

I love the description of the epigastric pain. I read n i understand

Darlene Matthews on November 24, 2013:

Very helpful information. Happy to have found you.

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