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).
What are the Symptoms of Gastric Pain?
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.
When Should I See a Doctor for Gastric Pain?
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.
What Causes Gastric Pain?
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.
What are the Risk Factors for Gastric 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.
How Is Gastric Pain Diagnosed?
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.
How Is Chronic Gastric Pain Diagnosed?
Chronic gastric pain is diagnosed through a detailed and systematic evaluation, particularly when symptoms persist or recur over time. The doctor begins by taking a thorough medical history, including the duration, pattern, and possible triggers of the pain, as well as associated symptoms such as weight loss, vomiting, or changes in appetite. A physical examination is then performed to assess for abdominal tenderness or other clinical signs.
What tests help diagnose ongoing gastric pain?
Further investigations are often required to identify the underlying cause. These may include an upper gastrointestinal endoscopy to directly visualize the stomach lining and detect conditions such as ulcers, inflammation, or abnormal growths.
Testing for Helicobacter pylori infection, using a urea breath test, stool antigen test, or blood test, is also commonly performed. Additional imaging studies, such as ultrasound or CT scans, may be used to rule out other abdominal conditions. In more complex or unclear cases, specialized tests may be recommended to ensure an accurate diagnosis and appropriate long-term management.
What are the Treatment Options for Gastric Pain?
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.
What Treatments Are Used for Persistent Gastric Pain?
For gastric pain that is persistent, recurrent, or does not respond to initial treatment, a more targeted and sustained approach is required. This may include prolonged use of PPIs or step-down therapy depending on symptom control. If Helicobacter pylori infection is confirmed, a combination of antibiotics is prescribed to fully eradicate the bacteria.
Additional medications such as sucralfate may be used to protect the stomach lining and support healing. Patients are also advised to follow dietary modifications, including avoiding spicy, acidic, or fatty foods, eating smaller meals, and reducing stress levels.
In cases where symptoms persist despite treatment, further medical evaluation is necessary. Diagnostic procedures such as endoscopy may be recommended to assess for underlying conditions such as ulcers, chronic gastritis, or more serious disorders.
Early and appropriate management of persistent gastric pain is important to prevent complications and improve overall digestive health.
How Much Do Treatments for Gastric Pain Cost in Singapore?
Gastric pain may require medical evaluation, which could include procedures such as endoscopy, imaging, or laboratory tests. In Singapore, these investigations are often hospital-based, and coverage depends on the type of procedure and the patient’s insurance or Medisave eligibility. Hospitalisation procedures and approved day surgeries may be covered under Medisave, private insurance policies, or corporate health benefits, while outpatient tests may have specific Medisave limits. Financial counselling is typically offered prior to hospital procedures to explain costs and help patients plan. The Ministry of Health provides fee benchmarks for transparency. Patients are encouraged to confirm coverage and eligibility with their insurance providers and hospitals before proceeding with any investigations or treatment.
