Stomach Pain
Symptoms, Causes & Treatment
Stomach pain (epigastric pain) is one of the most common presentations in primary care. The underlying cause ranges from benign functional dyspepsia to surgical emergencies requiring immediate hospital care. Accurate assessment ensures timely and appropriate management.
What Causes Stomach Pain?
Stomach pain encompasses any discomfort in the upper abdominal region. The most common causes are H. pylori-related peptic ulcer disease, functional dyspepsia, GORD, gallstones, and NSAID-induced gastritis. Emergency causes including pancreatitis, aortic aneurysm, and perforation must be excluded in any patient presenting with severe acute epigastric pain.
Symptoms of Stomach Pain
The location, timing, radiation, and associated features of epigastric pain guide the diagnosis and urgency of investigation.
Epigastric or upper abdominal pain · Pain worse or better after eating · Gnawing, burning, or cramping sensation · Nausea · Belching or bloating · Loss of appetite · Feeling full quickly
Severe sudden epigastric pain radiating to the back (pancreatitis — emergency) · Vomiting blood or melaena (black tarry stools) · Rigid board-like abdomen (perforation) · Pain with fever and jaundice (ascending cholangitis)
Sudden severe epigastric pain radiating to back · Vomiting blood · Black tarry stools · Rigid abdomen · Jaundice with fever — call 999 immediately.
What Causes Stomach Pain?
Stomach pain arises from many conditions. Identifying location, character, timing, and associated features narrows the differential diagnosis and guides investigation.
Gastric ulcers are caused by H. pylori infection (70–80%), NSAID use, and excess acid production. They cause gnawing epigastric pain, often worsened by eating. Duodenal ulcers are more common and typically relieved by food.
Gastritis (inflammation of the gastric mucosa) causes nausea, vomiting, and epigastric pain. Acute causes include H. pylori, NSAIDs, alcohol, and stress. Chronic autoimmune gastritis leads to pernicious anaemia from B12 malabsorption.
Acute pancreatitis causes sudden severe epigastric pain radiating to the back, nausea, vomiting, and raised serum amylase/lipase. The most common causes are gallstones (40%) and alcohol (40%). It requires urgent hospital admission.
Biliary colic from gallstones causes sudden severe right upper quadrant pain, often after fatty meals, with radiation to the right shoulder. Cholecystitis (infected gallbladder) presents with fever and peritoneal signs requiring urgent surgery.
Functional dyspepsia causes recurrent upper abdominal pain, early satiety, and nausea without identifiable organic cause. Rome IV subgroups: postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Treated with PPIs and gut-directed therapy.
Aortic aneurysm rupture, mesenteric ischaemia, and inferior myocardial infarction can all present with acute epigastric or diffuse abdominal pain. These are immediately life-threatening and require 999 emergency care.
Key Risk Factors
Diagnosing Stomach Pain
H. pylori testing, blood tests, ultrasound, and endoscopy are the key investigations, depending on whether alarm features are present and the likely diagnosis.
Treatment for Stomach Pain
Treatment targets the underlying cause. H. pylori eradication heals peptic ulcers. PPIs treat acid-related conditions. Surgery is required for gallstones, pancreatitis complications, and GI perforation.
Supportive Measures
Take PPIs or antacids as prescribed. Eat small frequent low-fat meals. Avoid alcohol, NSAIDs, and smoking. Apply a warm heat pack. Stay hydrated. Sit upright after meals. Seek urgent care for any sudden worsening of pain.
Managing Chronic Stomach Pain
Chronic dyspepsia requires long-term management. H. pylori should be eradicated when found. PPIs should be used at the lowest effective dose with annual review. Gallstones causing recurrent biliary colic are best treated by laparoscopic cholecystectomy to prevent complications.
When to Seek Help
Sudden severe epigastric pain radiating to back · Vomiting blood · Black tarry stools · Rigid abdomen · Pain with jaundice and fever — call 999 immediately. These are surgical emergencies.
See a GP for recurrent or persistent epigastric pain, especially if over 55 or with alarm features. An online GP consultation can arrange H. pylori testing and ultrasound without delay.
Preventing Stomach Pain
Most common causes of stomach pain are preventable through H. pylori eradication, safe NSAID use, alcohol moderation, and low-fat diet.
Test for H. pylori if you have recurring indigestion or dyspepsia. Early identification and eradication treatment heals peptic ulcers in over 90% of cases and dramatically reduces the risk of recurrence.
If you take NSAIDs regularly, take them with food and discuss gastroprotection with your GP. Co-prescribing a PPI significantly reduces the risk of NSAID-induced gastritis, peptic ulcer, and GI haemorrhage.
Reduce alcohol intake to within recommended limits (14 units/week maximum). Alcohol directly damages the gastric mucosa, triggers biliary colic, and is one of the two most common causes of acute pancreatitis.
Eat a low-fat diet to reduce biliary colic from gallstones. Maintain a healthy weight, as obesity is the leading risk factor for gallstone formation. Rapid weight loss also increases gallstone risk — lose weight gradually.
Attend gastroscopy if you have alarm features (dysphagia, haematemesis, melaena, unexplained weight loss, or new dyspepsia over 55). Early endoscopy identifies peptic ulcer, Barrett's oesophagus, and gastric cancer.
Stop smoking. Smoking increases gastric acid secretion, reduces mucosal prostaglandins, and is an independent risk factor for peptic ulcer disease and delayed ulcer healing.
Getting Treatment
A GP can arrange H. pylori testing, ultrasound for gallstones, prescribe PPIs, and refer urgently for endoscopy when alarm features are present. An online consultation is a good first step for non-emergency epigastric pain.
Expert clinical advice, when you need it.
Stomach Pain — Frequently Asked Questions
The most common causes of epigastric pain are H. pylori-related peptic ulcer disease, functional dyspepsia, GORD (acid reflux), gallstones (biliary colic), and NSAID-induced gastritis. In adults over 55 with new dyspepsia, endoscopy is recommended to exclude gastric cancer. A GP can assess symptoms and arrange appropriate investigations.
Call 999 immediately for sudden severe epigastric pain radiating to the back (possible pancreatitis or aortic aneurysm), vomiting blood, black tarry stools, severe pain with a rigid abdomen (perforation or peritonitis), or epigastric pain with jaundice. These are surgical or vascular emergencies.
Peptic ulcers are sores in the stomach (gastric ulcers) or the first part of the small intestine (duodenal ulcers). They cause burning or gnawing epigastric pain, often worsened by food (gastric) or relieved by food (duodenal). H. pylori infection is the most common cause. Eradication therapy heals over 90% of ulcers permanently.
H. pylori is diagnosed by urea breath test (most accurate non-invasive test), stool antigen test, or gastric biopsy at endoscopy. Treatment is 7-day triple therapy (PPI + clarithromycin + amoxicillin). Eradication should be confirmed 4 weeks later by repeat breath test or stool antigen test.
Gallstones cause right upper quadrant pain, often after fatty meals, which may radiate to the right shoulder or scapula. Episodes typically last 1–6 hours. Cholecystitis (infected gallbladder) adds fever and peritoneal tenderness. Gallstones are treated by laparoscopic cholecystectomy — a highly effective day-case procedure.
Acute pancreatitis causes sudden severe epigastric pain radiating to the back, with nausea, vomiting, and fever. It is most commonly caused by gallstones (40%) or alcohol (40%). Pancreatitis is a hospital emergency requiring IV fluids, analgesia, and close monitoring. Recurrent pancreatitis may damage the pancreas permanently.
Functional dyspepsia is recurrent upper abdominal pain or discomfort (early satiety, postprandial fullness, nausea) without an organic cause identified at endoscopy. It is very common and often responds to H. pylori eradication (if positive), PPI therapy, dietary modifications, and low-dose tricyclic antidepressants for pain sensitisation.
A GP can test for H. pylori and prescribe eradication therapy, arrange ultrasound for gallstones, prescribe PPIs for acid-related pain, and refer urgently for endoscopy when alarm features are present. An online consultation is a good first step for non-emergency epigastric pain.