Epigastric Pain Causes

Written by amanda davis
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Epigastric Pain Causes
Epigastric pain can have a variety of causes. (Jupiterimages/Polka Dot/Getty Images)

Epigastric pain is an ache or soreness in the upper and middle portions of the abdomen, just below the sternum. There are a variety of causes for abdominal pain, and it is often difficult to pinpoint the exact cause without extensive testing. Gastro-oseophageal reflux disease, lactose intolerance, gallstones and pancreatitis are a few of the most common causes of epigastric pain.

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Gallstones are hard, small stones that form in the gallbladder, which is in the upper abdomen and just below the liver. Gallstones can be asymptomatic, especially during the first few years after they develop. Pain can range from minor to severe and is generally chronic. This pain is usually steady and gnawing, and it occurs mainly in the portion of the abdomen under the ribcage. Severe gallstone attacks can produce pain that radiates into the back as well.

Lactose Intolerance

Lactose is the major sugar found in dairy products such as milk and yoghurt. Lactase is an enzyme, produced by the small intestine, that helps break down lactose. People who don't produce enough lactase have difficulty digesting lactose. Lactose that cannot be broken down and absorbed remains in the intestine until it is excreted via bowel movements. This can cause severe abdominal bloating, pain and discomfort in the upper abdomen. Lactase deficiency sometimes can be relieved through medications and by simply avoiding lactose.


Gastro-oseophageal reflux disease is a painful condition in which food and liquids leaks back into the oesophagus after being consumed and entering the stomach. Pain and pressure are most often felt in the chest under the breastbone and in the abdomen immediately below the ribs. This pain is often increased by eating, lying down, stooping and bending, because those actions put extra pressure on the affected area.


The pancreas is a gland behind the stomach that produces insulin, glucagon and digestive enzymes. During pancreatitis, this gland becomes inflamed. Abdominal pain, especially in the epigastric region, is common with pancreatitis. Pancreatitis can be acute or chronic, and these two types are treated differently. Pancreatitis is often associated brought on by gallstones.

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