Causes of epigastric abdominal pain

Epigastric	Clinical features	Comments
Acute myocardial infarction	May be associated with shortness of breath and exertional symptoms.	Consider particularly in patients with risk factors for coronary artery disease.
Acute pancreatitis	Acute-onset, persistent upper abdominal pain radiating to the back.
Chronic pancreatitis	Epigastric pain radiating to the back.	Associated with pancreatic insufficiency.
Peptic ulcer disease	Epigastric pain or discomfort is the most prominent symptom.	Occasionally, discomfort localizes to one side.
Gastroesophageal reflux disease	Associated with heartburn, regurgitation, and dysphagia.
Gastritis/gastropathy	Abdominal discomfort/pain, heartburn, nausea, vomiting, and hematemesis.	Variety of etiologies including alcohol and nonsteroidal antiinflammatory drugs (NSAIDs).
Functional dyspepsia	The presence of one or more of the following: postprandial fullness, early satiation, epigastric pain, or burning.	Patients have no evidence of structural disease.
Gastroparesis	Nausea, vomiting, abdominal pain, early satiety, postprandial fullness, and bloating.	Most causes are idiopathic, diabetic, or postsurgical.

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