Many conditions affecting an array of different organs and structures can cause pain in the upper stomach, or abdomen. Medical conditions that trigger this symptom vary from relatively mild ailments to potentially life-threatening disorders. Fortunately, common causes of upper abdominal pain tend to be the less serious than more rare causes. The nature, location, intensity, frequency and timing of the pain as well as accompanying signs and symptoms help narrow the list of potential causes of upper abdominal pain.
Stomach and Esophagus Ailments
Inflammation of the stomach lining, or gastritis, commonly causes gnawing or burning pain in the right or middle upper abdomen. Other possible symptoms include reduced appetite, nausea, vomiting and hiccoughs. The condition often develops due to a stomach infection with H. pylori bacteria, excess alcohol consumption, or frequent use of nonsteroidal anti-inflammatory medicines, such as aspirin or ibuprofen (Advil, Motrin). Stomach ulcers often cause symptoms similar to those of gastritis, and share the same risk factors.
Inflammation of the esophageal lining, or esophagitis, also frequently causes upper abdominal pain -- typically just below the breastbone. Reflux of stomach contents into the esophagus is frequently to blame, causing heartburn. Infections of esophagus generally cause more severe, persistent burning pain that often extends upward into the chest. These infections most often occur in people with a weakened immune system.
Gallbladder and Liver Disorders
Gallbladder and liver disorders frequently cause pain in the right or middle upper abdomen. Symptomatic gallbladder disease most often occurs due to obstruction of bile flow into the small intestine by gallstones. Typical symptoms of a gallbladder attack include sudden, intense pain in the right upper abdomen, often accompanied by nausea and vomiting. The pain often persists for several hours and may extend into the right shoulder. Pain lasting longer than 6 hours often indicates inflammation or infection of the gallbladder, which typically requires emergency surgery.
A variety of liver disorders can cause right upper abdominal pain. Liver inflammation, or hepatitis, often provokes mild to moderate pain -- especially if the condition evolves rapidly, or acutely. Common causes of hepatitis include viral infections, alcohol abuse, and toxic overdoses of medications or herbs. Other possible symptoms include fatigue, loss of appetite, nausea, vomiting, dark urine and yellow discoloration of the skin.
A wide variety of ailments affecting the small or large intestine can cause upper abdominal pain. Ulcers of the first section of the small intestine, or duodenum, are common. They cause pain and symptoms virtually identical to stomach ulcers. Other intestinal ailments that might cause upper abdominal pain include irritable bowel syndrome (IBS), diverticulitis, Crohn disease, colon obstruction, early appendicitis, and impaired blood flow to the bowel, a condition called mesenteric ischemia. These disorders can cause pain in different areas of abdomen. Accompanying signs and symptoms vary, depending on the intestinal condition.
Pancreas and Spleen Disorders
Inflammation of the pancreas, or pancreatitis, typically causes pain in the upper abdomen that often radiates to the back. Acute pancreatitis pain is usually more severe than that associated with chronic pancreatitis. Other symptoms may include bloating, nausea, vomiting, weight loss, fatty stools and fever. Pancreatitis risk factors include excess alcohol consumption, gallstones, smoking and cystic fibrosis.
Spleen disorders less frequently cause upper abdominal pain. The spleen is an immune system organ that performs a variety of functions. Situated in the left upper abdomen, this organ sometimes causes pain in this location. Traumatic upper abdominal injuries, sickle cell disease, leukemia, certain infections and other conditions that cause spleen enlargement can lead to upper abdominal pain.
A number of other medical conditions can provoke upper abdominal pain, although discomfort in this location might be atypical with some of these ailments. Doctors typically turn their attention to these less frequent causes after more common conditions have been ruled out. A partial list of less frequent causes of upper abdominal pain includes:
-- heart attack
-- lower lobe pneumonia
-- blood clot of the lung, or pulmonary embolism
-- kidney infection or stone
-- rupture or dissection of the aorta
-- ectopic pregnancy
-- abdominal infection or abscess
-- diabetic ketoacidosis
-- musculoskeletal conditions of the abdominal wall
-- tumors of the digestive system, kidney, pancreas or spleen
Warnings and Precautions
See your doctor if you experience unexplained persistent or recurring upper abdominal pain. Seek emergency medical care if your pain is severe or increasing, or if it is accompanied by any warning signs or symptoms, including:
-- fever or chills
-- rapid breathing or shortness of breath
-- dizziness, lightheadedness or fainting
-- agitation, irritability or confusion
-- rapid or pounding heartbeat
-- persistent vomiting
-- vomiting blood or material the resembles coffee grounds or has a stool-like odor
-- bloody, maroon or black stools
Reviewed and revised by: Tina M. St. John, M.D.