Epigastric Pain: Quick Guide to Causes and What to Do
Epigastric pain is discomfort in the upper middle belly just below the ribs. It can be sharp, burning, gnawing or a dull ache and may come and go or last hours to days. Knowing common causes helps you decide what to try at home and when to see a doctor.
Common causes
Acid reflux and gastritis are top culprits — acid irritates the stomach lining and creates burning pain. Peptic ulcers cause a gnawing or hungry feeling that often improves after eating or taking antacids. Pancreatitis gives severe, constant pain that can radiate to the back and comes with nausea or vomiting. Gallbladder attacks hurt under the right rib but you may feel them across the upper middle belly after fatty meals. Less commonly, heart problems, especially in older adults, can present as upper abdominal pain.
Other possibilities include medication side effects, functional dyspepsia, stress, or a muscle strain from sudden movement.
Try simple self-care first if the pain is mild and you have no red flags. Avoid heavy, greasy meals, stop alcohol, cut back on caffeine, and eat smaller portions more often. Over-the-counter antacids or H2 blockers can help short term; use proton pump inhibitors for persistent reflux but check with a doctor if you need them for more than two weeks. Stay hydrated and try a bland diet of toast, rice, bananas, and applesauce while symptoms settle.
When to get help and tests
Go to the emergency room if the pain is sudden, severe, comes with fainting, sweating, shortness of breath, or pressure in the chest. Also get urgent care for persistent vomiting, bloody or black stools, high fever, or yellowing of the skin or eyes. Your doctor will ask about pain timing, food links, medications, alcohol and smoking, then do an exam to pinpoint tenderness or guarding. Common tests include blood work, an abdominal ultrasound, H. pylori testing, and endoscopy if ulcers or persistent symptoms are suspected.
Treatment depends on the cause: antacids and acid blockers for reflux, antibiotics for H. pylori, enzyme support or fasting for pancreatitis, and surgery for severe gallbladder disease. If medications you take may be to blame, your doctor can switch drugs or adjust doses. Lifestyle changes like weight loss, quitting smoking and avoiding late meals often make a big difference for reflux and chronic indigestion.
Write down when pain starts, what you ate, and any medicines taken before appointments to speed diagnosis. If tests are normal but discomfort continues, ask about functional dyspepsia treatment, gut-directed therapy, or seeing a gastroenterologist. Most epigastric pain is treatable once the cause is found, so don’t ignore worrying signs and get checked when pain is severe or repeated.
Avoid regular use of NSAIDs like ibuprofen if you have stomach pain, since they can cause ulcers or worsen bleeding risk. Try a brief trial of bland diet and antacids and see if symptoms drop; if they don’t, book a medical review within a week. Bring a list of all medications and any alcohol use to your visit to help your clinician find the cause faster today.
