Causes of Upper Middle Abdominal (Stomach) Pain

The upper abdomen is a part of the trunk between the lower ribs and the navel. Epigastrium is the medical term for the upper middle region which lies high up in the abdomen. It is approximately where the breastbone ends, although some of the abdomen is tucked under the ribcage and behind the breastbone.

Causes of Upper Middle Abdominal Pain

1. Esophageal (Gullet) Disorders

  • Upper central abdominal pain during swallowing may appear in esophageal varices (mainly in chronic alcoholics) or in esophageal ulcers due to prolonged gastric acid reflux
  • Strong painful cramps in the esophagus that may be felt behind and below the breastbone may be due to:
    • Dry food
    • Hard passage of the food because of the dry esophageal mucosa (in dehydration), overgrown fibrous tissue (strictures) in prolonged GERD or, rarely,  in systemic sclerosis
    • Improper relaxation of the muscles that embrace the stomach entrance (cardia) due to damaged nerves (mostly during surgery)

Diagnosis is made from history or by upper endoscopy (esophagoscopy).


Gastro-esophageal reflux disease (GERD) refers to back-flow of gastric acid into esophagus. Burning pain below and behind the breastbone and/or in the throat and acidic taste in mouth are main symptoms. The cause is inadequate closure of the stomach entrance from various reasons, like herniation of the upper part of the stomach through a widened opening in the diaphragm (hiatus hernia). Diagnosis  is made from symptoms, upper endoscopy and measuring of pressures and pH in the esophagus.

3. Gastritis

Gastritis (Latin gaster = stomach; -itis denotes inflammation) is inflammation of the inner layer (mucosa) of the stomach with one or more of the following symptoms:

  • Burning pain below the breastbone, worsening during or after the meal
  • Nausea and vomiting
  • Early satiety
  • Excessive belching (burping)
  • Fever
  • Heartburn, burning feeling behind the breastbone and/or in the throat
  • Abdominal cramps
  • Black stools

The causes of acute (sudden) gastritis include infection with rotavirus (stomach flu) , mainly in children, food poisoning, excessive secretion of gastric acid, painkillers like aspirin or ibuprofen, acidic foods, spices and so on.

The causes of chronic (prolonged or recurrent) gastritis include infection by bacterium Helycobacter pylori, rare autoimmune gastritis (with vit B12 deficiency and anemia), chronic poisoning and so on.

In most cases, diagnosis of gastritis may be made from symptoms. In doubtful cases, X-ray with contrast (barium swallow) and upper endoscopy (gastroscopy) may be performed. White blood cells in the blood may (not necessary) be elevated and stool test for occult blood may be positive.

4. Gastroparesis

Gastroparesis refers to slow stomach emptying due to inadequate relaxation of muscles that embrace the stomach exit (pylorus) because of damaged nerves (mostly in long term atherosclerosis or diabetes), hormonal disorders, psychological reasons or fibrous tissue after healing of chronic gastric ulcer or after stomach surgery . Pain or cramping during or shortly after the meal in the upper middle abdomen, early satiety, heartburn, upper abdominal bloating and excessive belching (burping) are main symptoms. Diagnosis is made by gastric emptying tests.

5. Peptic Ulcer

  • Stomach ulcer is an open sore appearing in the inner layer (mucosa) of the stomach, which causes dull or burning pain in the upper middle abdomen during or shortly after the meal; avoiding eating and losing weight may follow.
  • Duodenal ulcer appears in the duodenum (the first part of the small intestine) and may cause dull or burning pain between meals and typically at night. Black stool from bleeding may appear in both gastric and duodenal ulcers.

Diagnosis of a peptic ulcer is made by upper endoscopy (gastroduodenoscopy).

6. Gastric Carcinoma (Stomach Cancer)

Stomach cancer may appear at any age but mostly in people after 50. Beside upper middle abdominal pain, nausea, poor appetite, losing weight and black stools are common. Diagnosis is confirmed by gastroscopy and examination of the sample of the gastric mucosa under the microscope.

7. Pancreatic Disorders

  • Inflamed pancreas. Acute pancreatitis is inflammation of the pancreas, mainly due to long term alcohol abuse or gallstones and may cause central or left side upper abdominal pain and nausea. Chronic pancreatitis usually results from repeating attacks of acute pancreatitis.
  • Pancreatic cancer may be preceded by long term chronic pancreatitis, but it may arise from the healthy pancreas. Main symptoms are upper middle abdominal pain, poor appetite, losing weight and white diarrhea or floating stools.

Diagnosis. In acute pancreatitis, pancreatic enzymes in the blood are elevated. Diagnosis of chronic pancreatitis is usually made by CT; pancreatic enzymes in the blood are not typically changed. In pancreatic cancer, pancreatic amylase and CA-19-9 marker (not always) are elevated.

Video on Upper Middle Abdominal Pain

8. Muscle Tear

Muscle tear is usually due to injury (hit with a hard object, stitch with a sharp object or rupture during exercise). The injured spot is tender to the touch. Hematoma (blood collection) may build within the muscle and can cause a small visible (bluish) and palpable (soft) bulge. Diagnosis is made by physical examination and ultrasound.

9. Intestinal Hernia

A part of small intestine may protrude through a cleft in upper abdominal muscles. Pain and a soft bulge of a golf ball size are main symptoms. Doctor can usually give diagnosis after physical examination.

10. Broken Breastbone

  • Broken xiphoid (the lower part of the breastbone) may cause upper middle abdominal pain. Diagnosis is made by X-ray.
  • Costohondritis – inflammation of the connection between the bony and cartilaginous parts of the lower ribs (about an inch from the breastbone on each side) may appear as chest and upper middle abdominal pain. Lower rib(s) may be tender to the touch. Diagnosis is made by physical examination.

11. Spinal Disorders

Bulging or herniated disc, spondylitis (spinal arthritis), broken vertebra or other disorder in the chest or lumbar part of the spine may cause upper middle abdominal pain and middle or lower back pain. Pain usually changes with moving or body position, aggravates with sitting and is relieved by walking. Diagnosis is made by CT or MRI.

12. Aneurysm or Dissection of Abdominal Aorta

In patients over 50 years of age, the wall of the aorta may be weakened due to atherosclerosis or other disorder leading to aortic wall bulging (aneurysm) or splitting of its layers (dissection). Constant dull upper abdominal pain that worsens during or after the meal is the main symptom. Diagnosis is made by the ultrasound, CT or MRI.

13. Heart Attack

Heart attack may appear with upper middle or left upper abdominal pain and is rare before 40 years of age. Smoking and high blood cholesterol are two important risk factors. Diagnosis is made on the basis of symptoms, ECG and elevation of certain enzymes in the blood.

14. Lymphoma

Enlarged lymph nodes near the stomach, appearing in gastric lymphoma may be painful. Low grade fever, paleness, fatigue and losing weight are other symptoms of lymphoma. Diagnosis is made by CT or MRI.

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About Jan Modric (249 Articles)
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  • Zoya

    Hey, I’m a fifteen year old girl, and I’ve been experiencing dull pain in my upper middle abdomen and just above my navel. It’s been happening for the past two to three days and intensifies if I put pressure on it, or I move around. Also, I’m supposed to take 75 mg of Zoloft everyday, but I recently stopped taking it recently, without titrating myself off of them (against my psychiatrist’s orders). Could that have anything to do with it?

  • Nina Bates

    I just started having pretty severe pain in my upper stomach region. It started two days ago. I have no appetite at all and it’s hard to touch even. I’m 56 years old and do not know my family history

  • Hi Nina. There are seveal possibilities for you symptoms, ranging from gallstones to gastritis, peptic ulcers, pancreatitis and so on as you can see from the article above. Pain on its own without other more specific symptoms can be difficult to diagnose. Some of the possible causes may not be too much to worry about but other causes can be very serious. It is therefore advisable that you speak to your doctor so he/she can do the necessary tests to diagnose the problem.

  • Dee Ann Rawlings

    I have upper abdominal pain that is right under my breast bone and runs to under my left ribs. Sometimes it goes through to my back. I tis worse after meals. Esp greasy or spicy. I had gastric bypass and gall bladder removal in 2004. I am a 54 yr old female. I have had 4 other abdominal surgeries as well. I have been experiencing “attacks” where the pain bores through to my back. I have frequent loose yellow stools that leave a oil film in the toilet water. my abdomen is increasingly swollen and tender. It is very uncomfortable to bend over and sit for long periods of time. T have some degree of pain most days and frequent nausea. I drank heavily for 20 years, but now just drink occasionally. Alcohol seems to cause increased pain also. Could this possibly be chronic pancreatitis? I am also anemic. Antacids don’t seem to help. Thanks for any opinions/recommendations you may have.

  • Hi Dee Ann. The pain and other symptoms are typical of pancreatitis. You could possibly have chronic pancreatitis but it is difficult to say for sure. Your lack of a gallbladder would further complicate your condition and contribute to symptoms like oily stool and loose stool. However, there may also be other conditions at play here as well which may have contributed to the overall clinical presentation, namely possible liver disease. This could be related your previous history of drinking or even be a result of other diseases. It is highly advisable that you see an internist and possibly a gastroenterologist as well as soon as possible.

  • alicat

    Hi, I’m 19 and I’ve had a tight squeezing pain in the upper middle part of my abdomen right below my chest. It started maybe about 3 years ago and is not constant it happens randomly about once or twice each year. It has only occurred in the morning time. It usually goes away after about an hour. Sometimes the pain is so intense that my hands starts shaking and none of the positions I try to get in help to relieve it. However, usually when I get this pain I’ll have to go to the bathroom which occasionally helps with the pain. My mom always days it’s because I sleep with a bra on, but I don’t think that’s the problem because then wouldn’t it hurt all the time? Please give me some recommendations on what this could be or even how to relieve the pain so when it happens again I can try to decrease the pain. Thank you!

  • Hi Alicat. There are many possible conditions that could cause these symptoms as you can see from the article above. Pain on its own is difficult to diagnose so it would be worthwhile to speak to a doctor who can assess you further before making a diagnosis. Some of the possible conditions that may be considered from what you describe would be gastritis, a hiatal hernia and even gallstones. The bra issue cannot be entirely discounted but it would be difficult to exclude since this pain occurs so infrequently. Given the situation it is difficult to say for sure. We do not provide any advice on treatment on this Q&A platform. That has to be decided by your doctor.

  • Avery

    Hi, i am 23 y/o female who has never experienced any types of gastric pain until recently. I never went to a doctor but based on the symptoms that i googled around, i found out that i have an anxiety. Two weeks ago i feel burning sensations in my stomach that comes and goes… The pain is lesser when i laid down. Now, the pain has gone but instead replaced by this uncomfortable feeling in the middle of the abdomen just below the ribcage. The feeling isnt exactly painful but rather feels like something tight and squeezing and its really uncomfortable when i sit down… It lasts from few days ago till present. The pain feels the same before and after meals. I also burped a lot which sometimes relieved the pain a bit but only for a moment like 1 to two minutes… Please give me some advices on this… Also on whether i should consult a doctor right away since i have a medical check up appointment in one month. Thank you.

  • Hi Avery. Yes, you should consult with a doctor about your symptoms. There are many possible conditions, from gastritis and peptic ulcers to a hiatal hernia or gallstones. As you can see from the article above there are many different conditions that cause pain in the same region. Your doctor will have to examine you further and take all your symptoms into consideration. Further diagnostic investigation may be necessary to confirm/exclude conditions that are suspected.

  • Peter Kenny

    Hi, I’m 57 years old male and have recently had a bout of gastroenteritis. This occurred while on holiday in Florida. When I returned I was still ill for approximately 5 days. I then went back to work and everything was fine for about 8 days. However several days ago I began to get dull stomach pains just below my breastbone. This tends to get worse as the day goes on. It seems to spread to the ribs. I was hoping you would know whether this is related to the gastroenteristis or do I need to have it looked at. Thanks in advance.

  • Hi Peter. It is difficult to say for sure whether this would be related to the previous bout of gastroenteritis. Usually gastroenteritis is viral and quickly resolves on its own. Complications (apart from dehydration) are not common. While this can be due to a number of other conditions, it is difficult to exclude whether this persisting pain is a complication of gastroenteritis. For example, dehydration that may arise with gastroenteritis can increase the risk of gallstones which may be responsible for your current pain. Best that you speak to your doctor if it is still present.

  • Rie

    I have had pain located under the middle of my ribs for the past few months, when it started I would touch the spot gently or lay onto my stomach and it would feel like I was being stabbed. The pain went away but it comes back here and there, and now it’s progressed and causing me to be nauseous.
    I’m not sure what it is, I assume it had to do with my liver but that also includes yellowing of the skin/eyes and I don’t have those symptoms.
    I don’t have money to really go see a doctor and live miles away from the nearest hospital.
    I’m not sure if it can be caused by the poor diet, or taking medication growing up.
    I’m not sure what it is. Neither do the nurses in my family understand what it is either.

  • Hi Rie. Many possible causes as you can see from the article above. Tenderness in the area in addition to the other symptoms you mention makes it more likely to be a gallbladder or pancreas problem. Both can cause pain and nausea. Of course it could be some other cause and even something as mild as muscle strain. However, there is no way of saying for sure at this point. Despite the financial restriction you need to seek professional medical attention even if it means attending a public health facility. The fact that it has been there for months and not got any worse till now should not mislead you into believing that everything will be fine. The condition can suddenly progress and possibly lead to complictions which could be very serious. A doctor will be able to advise you further.