Epigastric Pain – Causes, Diseases, Location and Symptoms

The abdomen is the largest portion of the torso and also has the largest cavity with the most amount of organs within it. There are a host of problems that can arise in the abdominal cavity and with the different organs crammed within it, it is sometimes difficult to identify an exact cause of symptoms. Often the approach to determining the cause of symptoms, like pain, is to first isolate the region in the abdomen from where it arises.

What is epigastric pain?

Epigastric pain is any discomfort, tenderness or pain that arises from the upper middle portion of the abdomen. This area is known as the epigastrium when dividing the abdomen into nine equal regions. The pain may vary in nature (sharp, cramping, burning, and so on) and intensity (from mild to severe) depending on the underlying cause as well as the individual perception and tolerance of pain.

The causes of epigastric pain is often related to the digestive system. However, there are instances where epigastric pain may be misleading. Although the region is mainly occupied by digestive organs, in some cases epigastric pain may be due to a problem with the heart, the lining around it or the diaphragm (flat muscle sheet that divides the chest and abdomen). In other instances epigastric pain may be referred pain originating elsewhere in the abdomen.

Organs in the Epigastrium

There abdominal regions are not compartmentalized internally, meaning that an organ in one region may extend into another. A change in body position can also displace organs to a slight degree. When it comes to the epigastrium the following are the main organs to occupy this region:

  • Liver
  • Pancreas
  • Gallbladder and bile ducts
  • Stomach
  • Duodenum (small intestine)
  • Abdominal aorta

However, it is important to note that only a portion of these organs sit in the epigastrium. For example, most of the stomach lies in the left hypochondriac region with the end portion (pylorus) extending into the epigastrium. It is also important to consider problems with the abdominal wall which may be the source of the pain.

abdominal regions

Causes of Epigastric Pain

Based on the organs lying in this region, epigastric pain is therefore usually due to liver, pancreas, gallbladder, bile duct, stomach, duodenum and/or abdominal aorta conditions. While diseases of these organs should first be investigated, the presence of other signs and symptoms may also warrant investigating other organs outside of the epigastrium.

Read more on upper middle abdominal pain.

Liver and Gallbladder

Although liver pain is generally associated with the right upper quadrant it can sometimes be felt in the midline, within the epigastric region. Waste and other byproducts from the liver are excreted through bile which is stores in the gallbladder temporarily. The pain with most gallbladder conditions are more centrally located within the epigastrium but may also be slightly towards the right of the midline.

Symptoms associated with liver and gallbladder conditions includes:

  • Nausea and vomiting
  • Loss of appetite
  • Jaundice
  • Change in body weight
  • Diarrhea

Some of the conditions that may give rise to this liver pain includes:

  • Hepatitis which is inflammation of the liver. Most cases are due to viral infections although certain toxins including alcohol and autoimmune conditions can also cause hepatitis.
  • Gallstones are tiny hard masses that form within the gallbladder from bile. It can then become obstructed in the gallbladder duct or bile duct. Sometimes stones can form in the bile duct.
  • Cholecystitis is inflammation of the gallbladder that may occur with gallstone or infections. Cholangitis is inflammation of the bile duct usually due to an infection.
  • Cancer is where a malignant growth develops in the liver or gallbladder, or spreads from elsewhere in the body to the liver by way of the bloodstream, lymphatic system or direct spread (metastasis).
  • Benign liver tumors like a hepatic adenoma develop when the liver cells multiply excessively to form a mass. It is not cancerous.
  • Liver abscess is where pus collects within the liver tissue and is often associated with an infection of the liver or in and around the liver within the abdominal cavity.
  • Bile duct or liver cysts are fluid filled masses that form in an around the bile duct or liver. The cause is not always known although one type, a hydatid cyst, may be due to a liver parasite infestation.
  • Acute liver failure may present with pain depending on the cause although chronic liver failure is usually painless.
  • Fatty liver disease is a condition where there is extensive fat tissue within the liver and is usually not due to alcohol or drub abuse. It is mainly linked to obesity. It is usually painless.
  • Other:
    – Portal vein thrombosis
    – Hepatic vein obstruction
    – Hepatic artery occlusion

Read more on liver diseases.


The pancreas is a long gland that extends across the midline of the upper abdomen. The location, nature and severity of pancreatic pain depends on the part of the organ that is affected and the underlying disease. Other symptoms include:

  • Nausea and vomiting
  • Loss of appetite
  • Pain extending to the back
  • Abdominal tenderness

These symptoms are mainly due to the following conditions:

  • Pancreatitis which is inflammation of the pancreas usually due to enzymes that activate within the pancreas and damages pancreatic tissue. It can be acute or chronic.
  • Pancreatic cancer where a malignant growth develops in the pancreas. It is usually associated with chronic pancreatitis and alcoholism.
  • Pancreatic cysts are enclosed fluid-filled sacs within the pancreatic tissue. Some can be present from birth (congenital) or may be cancerous. Pseudocysts are the more common type.
  • Trauma to the pancreas can arise with blunt or sharp force injury to the abdomen. A blow to the abdomen like with an assault, contact sports or car accident are some of the more common causes.

Read more on pancreas problems.

Stomach and Duodenum

Pain in the stomach and duodenum is usually described as burning or gnawing in nature. It tends to be worse during and after eating or when hungry. Some of the possible conditions that may give rise to epigastric pain includes:

  • Gastritis is inflammation of the stomach that is usually associated with excessive use of NSAIDs and H.pylori infection. The inflammation can extend to the lower end of the esophagus and the duodenum.
  • Peptic ulcers are open sores that form in the walls of the stomach or duodenum. It is often preceded by severe inflammation that leads to erosion of the wall.
  • Cancer of the stomach or duodenum is not uncommon. These malignant growths may often involve the other due to the close proximity.

Read more on stomach problems.

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