Feeling pain in the pit of the stomach is a fairly common discomfort. We have all suffered it at some point in our lives after a copious meal or when we have consumed fatty, spicy or poorly tolerated foods. Also if we are very nervous we can feel the typical 'knot' in the stomach that happens when we can solve the problem that worries us. But you should be aware of some signs that could indicate that it is a more serious problem.
Dr. Antonio Moreno García, specialist in Digestive Diseases and spokesperson for the Spanish Foundation for the Digestive System (FEAD) explains to us what are the diseases that can cause this discomfort and when we should urgently go to the doctor because it can be something serious that compromises your lifetime.
What can be the causes of pain in the pit of the stomach?
The term doctors use to define pain in the pit of the stomach is epigastralgia . They refer to it when it is located in the upper quadrant of the abdomen, in the center and below the sternum.
Its causes can be multiple and, among them, we can classify them as digestive causes, which are the most frequent, and non-digestive causes.
They can occur suddenly and acutely. Although there are people who usually feel it for a long period of time and in episodes.
We have a very wide range of pathologies that cause pain in the pit of the stomach. They can range from mild conditions, such as gastroenteritis, to very serious such as a ruptured aortic artery aneurysm.
Stomach pain: digestive causes
- Gastroesophageal reflux disease . It occurs when stomach contents return to the esophagus irritating it.
- Gastroduodenal ulcer. They are sores that appear on the lining of the stomach.
- Infectious gastritis. It is an inflammation of the gastric mucosa and can be produced by a virus, bacteria or parasites.
- Gastritis due to the consumption of drugs such as anti-inflammatory drugs . Inflammation from taking these drugs without a drug that protects the stomach.
- Dyspepsia . Upper stomach pain, bloating, heartburn, and even nausea from indigestion, stress, drugs, or other causes.
- Meteorism or gases. It is the abdominal distention caused by the production and accumulation of an excessive amount of gases.
- Spasms of the esophagus. Painful contractions within the muscular tube that connects the pit of the stomach to the stomach.
- Esophageal achalasia . It is a disease of the esophagus in which it does not work properly and cannot expel food to the stomach.
- Lithiasis or stones in the gallbladder or common bile duct . The pain usually manifests on the right side of the abdomen and may be accompanied by vomiting.
- Acute or chronic pancreatitis. Inflammation of the pancreas.
- Acute appendicitis. Inflammation and infection of the appendix, a small sac located in the large intestine.
- Perforation of the stomach. Hole in the stomach, caused by an ulcer.
- Intestinal ischemia Death of gut tissue.
- Portal vein thrombosis. Obstruction of this vein, which is the one that carries blood to the liver from the intestine due to a clot.
- Cancer . Tumors of the stomach and biliopancreatic area.
Stomach pain: non-digestive causes
- Acute myocardial infarction . The heart does not receive enough blood due, in many cases, to clogged arteries.
- Dissection or rupture of aortic aneurysm . It is the main vessel that carries blood to the abdomen. An aneurysm is the abnormal widening of the aorta. Sometimes it can break due to its bulging and can be fatal)
- Pericarditis . Inflammation of the membranes that surround the heart.
- Muscle pain in the back that radiates forward.
- Neuralgias such as those that occur after suffering a herpes zoster infection.
The most common causes of stomach pain
Although, as you can see, there are countless causes that can cause pain in the pit of the stomach, the most common are pathologies related to:
- Calculi (stones) or lithiasis in the bile duct, such as biliary colic.
- Acute pancreatitis .
- Gastroesophageal reflux due to the presence of a bacterium, Helicobacter pylori.
How do you know if it is something serious?
So that the doctor can make a good diagnosis, it is very important that you keep track of the times of the day when you feel these discomforts. This will help you determine what tests will be needed to confirm what is causing the pain.
- Fasting . The pain that appears after a few hours of having eaten and that is relieved by taking food, should make us think of a gastric or duodenal ulcer.
- Pain in the pit of the stomach at night. If you wake us up at night the pain could be due to a reflux disorder that is made worse by position when we sleep. But if this situation continues and there is no acidity data, it would have to be ruled out with a doctor that there are pancreatic, gastric neoplasms, or circulatory problems.
- Pain in the pit of the stomach after eating . In this case, the most frequent causes are those related to gallstones or gallstones (biliary colic), gastroesophageal reflux disease, dysmotility-type dyspepsia and pancreatic disease such as chronic pancreatitis.
What tests are needed to diagnose stomach pain?
- Appointment with the doctor . In it, the specialist will do an interview where the doctor can obtain information on the characteristics of the pain and guide the complementary tests that will be done and in what order.
- Blood tests . It is important because it will be possible to know if there is anemia and of what type, or alteration of transaminases and cholestasis enzymes. All these markers will point towards a pathology related to the gallbladder or pancreatic.
- Ultrasound of the abdomen . It allows a very reliable assessment of abdominal structures. With it it will be possible to explore if there are stones in the gallbladder or in the bile duct, the morphology of the pancreas in case it is inflamed or there are lesions. You can also see the liver and abdominal circulation. Ultrasound can also identify inflammatory lesions in the stomach, small intestine, and colon.
- Upper digestive endoscopy. It consists of introducing a tube with an optic through the mouth. This test is usually done with sedation, so you won't notice anything. With it, the specialist will examine the esophagus, stomach and duodenum to assess the presence of irritation or lesions in the esophagus due to reflux, if there is a hiatal hernia, ulcers in the stomach and duodenum, gastritis or tumors. In addition, endoscopy allows the taking of samples, as well as treating ulcers if they present complications such as bleeding.
- 24-hour pH-metry . This test is performed if gastroesophageal reflux disease is suspected. It consists of placing a very fine catheter through the nose into the stomach to see if the acid from the stomach passes into the esophagus.
- Esophageal manometry . It is a test with high resolution equipment that provides information on how the esophagus works. It is done when doctors think the pain may be due to esophageal spasm, achalasia (a rare condition in which the esophagus cannot deliver food to the stomach), or another movement disorder of the esophagus. It consists of a small probe that is inserted through the nose into the stomach, measuring how it contracts and relaxes the muscles depending on whether we are swallowing or not.
- CT or MRI . If a problem with the bile duct or pancreas is suspected, after the ultrasound the doctor will advise a study by CT or Magnetic Nuclear Resonance (MRI) to evaluate the pancreas and / or the bile duct (cholangioMRI).
- Echoendoscopy . It is a technique that has represented a great advance in the study of the pathology of the upper digestive tract. It consists of an endoscope that is capable of performing an ultrasound through the esophagus, stomach and duodenum. With it, it is possible to see these organs closely, being very useful in the diagnosis of problems of the bile duct and pancreas, which due to their characteristics and anatomical location are difficult to evaluate. Being so close to the pancreas, it is able to study its characteristics well and take biopsy samples to study its lesions.
When can it be for something more serious?
You have to be very attentive and make an appointment with your doctor as soon as possible when these symptoms appear:
- Very intense acute pain , which does not subside or is accompanied by profuse sweating, nausea and vomiting. In these cases, it is advisable to go to an emergency department to rule out cardiac or other symptoms, such as acute pancreatitis.
- Dysphagia or difficulty swallowing solid and / or liquid food.
- Episodes of nocturnal regurgitation (vomiting) of food from the stomach to the mouth.
- Chest pain
- Unjustified weight loss , that is, you are not on any diet to lose weight.
- If blood is vomited or melenic stools appear (black and sticky like tar).
- Drowning episodes , especially nocturnal, related to regurgitation from the stomach.
