Abdominal Pain - Upper
Anatomy - Gastrointestinal
- Pain is primarily centered in the upper abdomen (i.e., just below rib cage and above belly button)
- There are multiple causes of upper abdominal pain.
- Gastritis and peptic ulcer disease are common and typically cause pain in the upper abdomen (epigastrium), sometimes accompanied by vomiting.
- Gastroesophageal reflux disease (GERD) causes a burning pain that radiates into chest. Lying down aggravates symptoms. May get a sour or bitter taste in mouth.
- Abdominal pain in the elderly carries with it a higher risk of serious illness.
Top Causes of Upper Abdominal Pain in Men Younger than 50 Years of Age
- Gallbladder disease
- Nonspecific abdominal pain
- Peptic ulcer disease
Top Causes of Upper Abdominal Pain in Individuals Older than 50 Years of Age
- Bowel obstruction
- Gallbladder disease
- Peptic ulcer disease
- Angina and heart attack
- Abdominal aortic aneurysm
- Herpes zoster
A Warning about "Indigestion": Some individuals can have a heart attack and just think that it is "indigestion". You should especially consider the possibility of a heart attack if you are over 40 years old or if you have any cardiac risk factors. Cardiac risk factors include: diabetes, hypertension, high cholesterol, obesity, smoking, and a family history of heart attack at an age of less than 60.
When to call your doctor
Call 911 Now (you may need an ambulance) If
- Passed out (fainted)
- Very weak (can't stand)
- Visible sweat on face or sweat is dripping down face
- Pain lasting more than 5 minutes and any of the following:
- History of heart disease (e.g., heart attack, bypass surgery, angina, angioplasty, heart failure)
- Over 50 years old
- Over 35 years old and you have at least one cardiac risk factor (i.e., hypertension, diabetes, high cholesterol, obesity, smoker or strong family history of heart disease)
Call Your Doctor Now (night or day) If
- You feel weak or very sick
- Severe pain
- Constant abdominal pain for more than 2 hours
- Pain lasting more than 5 minutes and age 40 years old and you also have chest, arm, neck, upper back or jaw pain
- Vomiting blood or black (coffee-grounds)
- Vomiting bile (bright yellow or green)
- Vomiting and abdomen looks much more swollen than usual
- Blood in bowel movements (black/tarry or red)
- Recent injury to the abdomen
- Fever of 103° F (39.4° C) or higher
- Fever of 100.5° F (38.1° C) or higher and you:
- Are over 60 years of age OR
- Have diabetes mellitus or a weakened immune system (e.g., HIV positive, cancer chemotherapy, chronic steroid treatment, splenectomy) OR
- Are bedridden (e.g., nursing home patient, stroke, chronic illness, recovering from surgery)
- Whites of the eyes have turned yellow (jaundice)
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
- You think you need to be seen
- Mild pain comes and goes (cramps), but lasts longer than 24 hours
- Over 60 years old
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns
- Abdominal pains are a recurrent problem
- Intermittent burning pains radiating into chest with sour taste in mouth
- Abdominal pains regularly occur about 1 hour after meals
Self Care at Home If
- Mild upper abdominal pain and you don't think you need to be seen
HOME CARE ADVICE FOR MILD UPPER ABDOMINAL PAIN
- Reassurance: A mild stomachache can be from indigestion, stomach irritation, or overeating. Sometimes a stomachache signals the onset of a vomiting illness from a viral infection.
- Fluids: Sip clear fluids only (e.g., water, flat soft drinks or ½ strength fruit juice) until the pain is gone for 2 hours. Then slowly return to a regular diet.
- Slowly advance diet from clear liquids to a bland diet.
- Avoid alcohol or caffeinated beverages.
- Avoid greasy or fatty foods.
- Stop Smoking: Smoking can aggravate heartburn and stomach problems.
- Avoid Aspirin: Avoid aspirin and anti-inflammatory medications (e.g., Motrin, Advil, Aleve, Naproxen). These medications can cause stomach irritation. Try taking acetaminophen (e.g., Tylenol), which does not cause stomach irritation.
- Antacid: If having pain now, try taking an antacid (e.g., Mylanta, Maalox). Dose: 2 tablespoons (30 ml) of liquid by mouth.
- Reflux Symptoms (GERD): Eat smaller meals and avoid snacks for 2 hours before sleeping. Avoid the following foods which tend to aggravate heartburn and stomach problems: fatty/greasy foods, spicy foods, caffeinated beverages, mints, and chocolate.
- Expected Course: With harmless causes, the pain usually lessens or is resolved in 2 hours. With gastroenteritis, stomach cramps may precede each bout of vomiting or diarrhea. With serious causes (such as appendicitis), the pain becomes constant and severe.
- Call Your Doctor If:
- Abdominal pain is constant and present for more than 2 hours.
- You become worse
Author: David A. Thompson, M.D.
Last reviewed: 10/11/2011
Last revised: 10/11/2011