Post-Prandial Gastric Pain
The term ‘stomach pain‘ is often used loosely to describe abdominal pain in general. However, it is widely accepted that the term ‘stomach pain‘ describes left upper quadrant (LUQ) abdominal pain. This is where the stomach is primarily located and most of it is tucked under the lower left rib cage. Refer to Stomach Location for more information on the anatomical position of the stomach.
There are many organs and structures around the stomach. Therefore it is difficult to isolate pain in this region as being solely associated with the stomach. Typically pain in the LUQ after eating, when hungry or associated with other upper gastrointestinal symptoms like excessive belching, stomach bloating, nausea, vomiting, or regurgitation. Pain and these other symptoms however, may not be due to actual pathology within the stomach itself.
The medical term for any event after eating is ‘post prandial’. Therefore stomach pain after eating is broadly referred to as post-prandial gastric pain. It is a common symptom in some conditions like gastritis, peptic ulcer disease and gastric outlet obstruction. However, there may also be various other causes that need to be considered. Enlargement of the stomach with food may also place pressure on other surrounding organs. In these cases post-prandial pain is not from the stomach itself.
Causes of Stomach Pain After Eating
Pain arising from the stomach after eating is most likely to occur due to one of three reasons.
- Gastric acid and stomach enzymes increase after eating.
- Stomach distends after eating solids.
- Strong contractions in the stomach wall start after food enters.
Normally these three processes do not cause any pain in the healthy stomach. However, when the stomach is diseased or damaged, these process can aggravate stomach pain.
Distension of the stomach after eating, secretion and action of digestive enzymes, muscle contractions associated with gut motility and impairment of normal motility are the primary causes of stomach pain.
Pains in the stomach specifically (gastric pain) after eating includes :
- Gastritis. Inflammation of the stomach lining usually caused by H.pylori infection or use of NSAIDs.
- Stomach ulcer. This is an open sore in the lining of the stomach (peptic ulcer) which arises in long term gastritis.
- Hiatal hernia. Protrusion of a portion of the stomach through the diaphragmatic opening.
- Mallory-Weiss tear. Esophageal tear at the junction of the esophagus and stomach which may follow violent vomiting or retching.
- Gastric outlet obstruction. Blockage of the terminal part of the stomach or junction between the stomach and duodenum often due to pyloric stenosis, stomach polyp, stomach cancer and other causes of delayed gastric emptying.
Non-gastric causes mean pain that is not related to the stomach itself but is often lined to digestion and absorption. Therefore it tends to occur after eating, either immediately after a meal or anywhere between 20 minutes to 3 hours after eating. It may also be related to specific foods and drinks, especially with spicy foods, alcohol, lactose, gluten, fructose and sorbitol.
- Pain in the left upper quadrant may be related to other abdominal or gastrointestinalorgans often as a result of distension of the stomach after eating, gastrointestinal activity (motility and digestive enzymes), and activation of the defecation reflexes :
- Pain towards the epigastrium (upper middle abdomen) may be related to increased gut activity following eating :
Other Causes of Stomach Region Pain
Some of these causes may not specifically aggravate after eating but are worth considering as possible causes. It may arise with the nerve and muscle activity associated with digestion, or distention of the stomach after solid food enters it, nutrients that enter the blood stream or other processes. However, this is often radiated or referred pain in the stomach region. This includes :
- Chest wall pain and abdominal wall pain – injury, rib fracture, muscle strain
- Myocardial infarction (heart attack) – Angina vs Heart Attack Pain
- Dissecting abdominal aortic aneurysm
- Pleuritis – left side chest pain
- Shingles (herpes zoster)
- Diabetic ketoacidosis
- Nerve root compression