Gastric Pain

What is Gastric Pain?

Gastric pain or “epigastric pain” is often described as pain in the middle upper abdomen. It is often referred to as “gastric” by people in Singapore. The word “gastric” means “of the stomach”. The stomach is a digestive organ located in the upper abdomen that follows the oesophagus. It is responsible for mixing and digesting food. While most pain in the upper abdomen does arise from the stomach, it is important to note that other causes include pain from organs such as the gallbladder, bile duct, pancreas and intestine (duodenum, appendix). 


Gastric pain symptoms tend to be mild and transient, often described as a burning sensation or bloatedness. It is often worse with hunger and relieved with food. Gastric pain needs to be distinguished from other causes of middle-upper abdominal pain such as gallstone pain which can be quite different. This type of pain tends to be excruciating with a sudden onset, usually prompting one to visit the emergency department. The pain may be accompanied by vomiting and cold sweats. Another cause of middle-upper pain could be pancreatitis which is usually very severe and unremitting and may radiate to the back. Pain caused by appendicitis may start in the upper abdomen but then localise to the lower right side of the lower abdomen as the disease progresses.


Seek medical attention at any gastric pain clinic if epigastric pain persists after simple over-the-counter remedies or if the intensity or character of the pain changes and you think this may be more than your usual “gastric” pain. This is especially true for those older than 35 years of age or, with alarming symptoms such as fever, cold sweats, recurrent vomiting, loss of weight, loss of appetite, black stool, difficulty swallowing and change in bowel habits. Additionally, those with a family history of gastrointestinal cancer should receive early screening. 


Gastric pain tends to be recurrent over years and of low intensity and characterised as ‘’burning’’. Many factors may contribute to pain including inflammation of the gastric lining, ulceration and also visceral hypersensitivity or an elevated awareness of pain.


Risk factors for gastric pain include female gender, helicobacter pylori infection, betel nut chewing, taking aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), smoking, alcohol, sleep disturbance, non-erosive reflux disease, irritable bowel syndrome, anxiety and depression.


The diagnosis of “gastric pain’’ is usually based on clinical symptoms and physical examination that can be done at any gastric pain clinic. However, a common investigation method would be a gastroscopy or upper gastrointestinal tract endoscopy, especially in cases where there may be alarming symptoms. A urea breath test is also available to exclude helicobacter pylori infection. If diagnosis is inconclusive, your gastric pain doctor may order blood tests or an ultrasound or CT scan of the abdomen to exclude other causes of abdominal pain. MRI or endoscopic ultrasound is rarely needed.


Gastric pain treatments usually involves a holistic approach involving identifying risk factors that may be causing the pain. Lifestyle changes such as smoking cessation and drinking alcohol in moderation are equally important. Patients taking aspirin and NSAIDs should be made aware of their risks by their gastric pain doctor. Treatment of helicobacter pylori is essential and provides long term risk reduction for stomach or gastric cancer. If experienced symptoms are mild and episodic, gastric pain treatment with over the counter medication such as antacids may be sufficient. If symptoms are more severe, a trial of treatment with proton-pump inhibitors (PPIs) is usually effective.