Upper Central Abdominal Pain

Causes, Diagnosis & Treatment Of Upper Abdominal Pain

What Is Upper Central Abdominal Pain?

Upper central abdominal pain is abdominal pain occurring just below the breast bone, at the top of the abdomen between both rib cages down to the level of the umbilicus or belly button. This part of the abdomen is also known as the epigastrium or epigastric region.

The upper central abdominal area has a number of important organs and structures which include:

• Skin
• Muscle
• Stomach
• Duodenum
• Pancreas
• Liver
• Aorta
• Blood vessels
• Gall bladder, if enlarged by stones

Pain in the upper central abdomen is often caused by conditions that do not pose an immediate threat to life.  However, it is important to exclude life threatening conditions which can cause pain in this region first.  These conditions include:

• Heart attack
• Dissecting thoracic aneurysm
• Ruptured abdominal aortic aneurysm

Although the heart is not housed in the epigastrium, the pain felt here can be a referred pain.

Common Causes Of Upper Central Abdominal Pain

There are many common reasons for upper central abdominal pain.  These include, in order of likeliness:

The upper central stomach area - between the belly button or umbilicus and the sternum contains part or the whole of the following organs:

• Skin and muscles in the centre of the upper abdomen
• Lower part of Oesophagus (also called gullet)
• The Stomach
• Duodenum or the beginning of the small intestines
• Part of the Pancreas
• Part of the Liver
• The Gallbladder could extend into this region if filled and enlarged by stones
  
• The aorta and other blood vessels that passes through this region
• Muscles and bones the make up the floor of the upper central abdomen and back.

Diseases or injuries affecting any of these structures or organs would lead to an upper central abdominal pain. Pain from the heart, although not directly situated in the epigastrium, can be felt here too (referred pain).

Therefore if you have upper central abdominal pain, any disease or infection affecting any one of these listed organs in the upper abdomen could be the cause. Let's go a bit further and try to understand how a disease or injury in each of these organs would manifest itself.

The following are the 11 common causes of epigastric or upper central abdominal pain:

1. Gastritis

Gastritis is an inflammation in the wall of the stomach and is a mild erosion of the lining of the wall of the stomach, without any ulceration.  It is a common result of extended periods of stress or excessive consumption of alcohol.  If you have recently drunk too much alcohol or experienced excessive stress and the pain is severe, dull, burning or sharp in character, it could be gastritis.  Some people say that the pain is similar to a knife piercing through to the back, between both shoulder blades.  You may also experience bloating and an aversion to food, preferring cold water instead.

Certain medications like ibuprofen or diclofenac, or aspirin, which belongs to the group of medications called non-steroidal-anti-inflammatory drugs (NSAIDS) can also precipitate gastritis, and indeed go beyond that to cause or worsen a stomach ulcer and even cause perforation of the stomach. Therefore, it is better to use paracetamol or co-codamol as pain relief.  Combining medications such as Omeprazole and Gaviscon will ease the symptoms and allow the stomach time to heal.

It is best to get your symptoms checked by a doctor if there is no improvement after a day or two.  Gastritis can present similarly to pancreatitis and can turn into an ulcer.  Only a blood test and/or endoscopy and ultrasound may help to differentiate between the two conditions. It is therefore important to seek medical help if there is no improvement.

2. Helicobacter Pylori Infection

Helicobacter Pylori is bacteria that is commonly found inside the stomach of most people.  If the bacteria multiples too much inside the stomach it can start to cause problems that lead to erosion and inflammation of the lining in the wall of the stomach.  This can lead to symptoms of gastritis or a stomach ulcer.  You will also feel bloated and potentially nauseous.  

Diagnosis of helicobacter pylori infection is made using a stool sample or a breath test.  This will confirm the presence of the bacteria in the upper abdomen.  With medication, the bacteria can be eradicated within two weeks using antibiotics and painkillers. 

The recommended treatment regime for this bug is the use of Omeprazole 20mg taken Twice Daily; Amoxicillin 1gram taken Twice Daily; And Clarithromycin 500mg Taken Twice Daily, all for seven days duration.  Another regime used for treatment of Helicobacter pylori is - Omeprazole 20mg Twice Daily, Metronidazole 400mg Twice daily And Clarithromycin 500mg Twice Daily, for those who are allergic to penicillin’s.

3. Indigestion

Indigestion is by far the most common cause of abdominal discomfort, with over 70% of us likely to experience it at some point or another in our lives.  The discomfort may be accompanied by a feeling of bloating, nausea and burping.  Indigestion is a result of trapped wind or indigestible material distending the stomach and resulting in gas escaping up via the oesophagus or even down, in the form of flatulence.

If the indigestion increases from discomfort to pain to severe pain within half an hour, it is important to seek medical attention urgently.  Heart attack often simulates the symptoms of indigestion to begin with.

4. Heartburn

Heartburn is different to indigestion and the two terms should not be used interchangeably. Heartburn is due to a reflux of acid from the stomach into the lower part of the oesophagus. This is often due to a weakness in the valve that controls the lower oesophagus.  It manifests itself as a burning sensation behind the breastbone, in the chest not the abdomen.  The burning sensation is often worse when lying down and often leaves a sour taste in the back of the throat or mouth.

The medical term for heartburn is Gastro-Oesophageal-Reflux-Disease (GORD) and is nothing to do with the heart. Heart attacks though can mimic heartburn, so if the symptoms progress you should see a doctor as soon as possible.

5. Stomach Ulcer

A gastric ulcer is an ulcer on the wall of the stomach.  The pain may worsen with eating and the sufferer may be reluctant to eat and therefore will appear to lose weight.  The pain may be sharp and pierce out towards the back and this pain is associated with feelings of nausea.  

It is common for the pain to be worse at night, between 11pm and 3am.  The pain may come in stretches of continuous attack, lasting between two and four weeks and then disappears.  It will then come back again after a while.  The symptoms can be eased with the consumption of milk or antacid.

When visiting your doctor, they can confirm an ulcer with the use of a camera passed down the throat to the stomach – this is known as an endoscopy.  It is important for them to rule out stomach cancer with this type of pain, especially if you are more than 50 years old.

6. Duodenal Ulcer

The symptoms of a duodenal ulcer are the same as a stomach ulcer.  The major difference is that eating would ease the symptoms as opposed to worsen them.  Therefore, the sufferer may gain weight.  The treatment is with Omeprazole or lansoprazole and the inclusion of Ranitidine if deemed necessary to expedite the healing of the ulcer.

7. Gallstones

Formed by bile, gallstones are produced in the liver and stored in the gall bladder.  These stones can block the gallbladder, leading to a gallbladder disease.  Biliary Colic and Cholecystitis are also two common conditions caused by gallstones.

8. Hiatus Hernia

The pain from the hiatus hernia may come on suddenly and be really quite severe.  It might be linked to vomiting and the feeling of something piercing the upper abdomen.  The pain is likely to be worsened by eating and relieved by vomiting.

9. Abdominal Aortic Aneurysm

An Abdominal Aortic Aneurysm is a ballooning and rupture of the aorta, which is the large blood vessel that carries blood from the heart to the body.  You will experience severe pain that starts in the upper central abdomen and radiates to the back. 

This type of condition is more common in people with high blood pressure and is associated with dizziness or feeling faint.  

It is diagnosed when a doctor orders an ultrasound or a CT scan. Treatment is by open or endoscopic surgical repair if there is only leaking and the aorta is not yet ruptured.

10. Angina

Angina is a problem with the heart but presents as upper central abdominal pain.  The pain may start as a dull crushing pain which becomes severe and spreads up to the chest and left arm. This pain is often brought about by exertion and will get better with resting.  The pain may result in vomiting, cold sweats and a slow or fast heart rate or palpation. The attack usually last for 10 to 15 minutes.

11. Heart Attack

Heart attack can present itself as angina as it is a severe and sudden pain which can begin in the upper central abdomen.  The pain is usually dull and then severe, it will also be crushing and spread to the chest, the left shoulder or the neck. It may also extend into the jaw.  Other symptoms include breathlessness and a feeling cold and clamminess.  You should seek help immediately, assuming this is a heart attack until proven to be otherwise.  

These are the common causes of upper central abdominal pain. Others include epigastric hernia, hepatitis, Benign Recurrent Intrahepatic Cholestasis (BRIC), herpes zoster (shingles) which impacts the skin over the upper central abdomen and pseudo pancreatic cysts. Appendicitis, in its very early phase may start at the epigastrium, but quickly moves downwards.

When To Seek Medical Advice

Before you seek medical advice, answer these questions: 

• Does the pain come on as a sharp or dull ache just below your sternum in the middle of your upper abdomen?
• Does it spread through the middle towards your back? Have you noticed that this pain tends to come after your means? Does it make you feel like vomiting sometimes?
• Does the pain wake you up at night?
• Is the pain a sharp piercing pain through the upper stomach?
• Do you feel bloated even after a small meal?

If you answered yes to any of these questions it is worth seeking medical attention.

References

Harvard Health Publications, http://www.health.harvard.edu/digestive-health/gastritis (Accessed: September 2016)

Harvard Health Publications, http://www.health.harvard.edu/staying-healthy/gerd-heartburn-and-more (Accessed: September 2016)

Patient.info, Causes of upper central abdominal pain, http://patient.info/leaflets/upper_central_abdominal_pain.htm (Accessed: September 2016)

Live Heathly, What Could Cause Upper Stomach Pain?, http://livehealthy.chron.com/could-cause-upper-stomach-pain-1889.html (Accessed: September 2016)

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