Tummy Trouble? What’s Behind the Pain

The pain in your belly may be mild or severe, and it may feel like a stomachache or a burning pain. But one thing is certain: You know it's there, right in the middle of your stomach. There are many reasons why you may be feeling this type of abdominal pain.

Abdominal pain located in your mid-abdomen, between your chest bone (sternum) and your belly button, is called epigastric pain, says the American College of Gastroenterology. "By far, the most common cause of pain in the middle or upper part of the belly is GERD, which is gastroesophageal reflux disease," says Brooks Cash, MD, chief of gastroenterology, hepatology and nutrition at the University of Texas Health Science Center at Houston.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains that GERD is caused by stomach juices coming up into your esophagus. Acid in your stomach juices causes the burning pain known as heartburn.

GERD is very common. It affects about one out of five people in the United States. You may be at higher risk for GERD if you smoke or you are overweight. NIDDK says that you may have burning pain in the middle of your abdomen along with these other symptoms:

• Bad breath.
• Nausea.
• Pain in your chest.
• Difficult or painful swallowing.
• A hoarse voice or cough.
• Loss of tooth enamel.

​Read more:​ The Dos and Don'ts of Eating With GERD

"Less common than GERD, but still a common cause of epigastric pain is functional dyspepsia," Dr. Cash says. Mayo Clinic describes functional dyspepsia as burning pain or discomfort in the upper abdomen that is sometimes relieved by eating or antacids, but has no definite diagnosis. Other symptoms of functional dyspepsia include:

• Bloating.
• Belching.
• Feeling full soon after eating.
• Nausea.

Mayo Clinic says you may be at higher risk for this cause of abdominal pain if you are older, female, use over-the-counter NSAIDs like Advil or Motrin, and if you are a smoker.

"People who have functional dyspepsia may need an endoscopic exam to look for a cause. The cause may be peptic ulcer disease," Dr. Cash says. An endoscopic exam is a flexible scope placed down your throat to examine your esophagus, stomach and upper part of your intestine.

"Pancreatitis is another possible cause of mid-abdominal pain. It is less common than GERD or functional dyspepsia," says Dr. Cash.

NIDDK says that pancreatitis is inflammation of your pancreas, which is a digestive gland located behind your stomach. You may be more likely to have this cause of mid-abdominal pain if you have diabetes, gallstones, high triglycerides, obesity, smoke or drink alcohol heavily. The agency says that these are the common symptoms:

• Pain in your upper abdomen that spreads to your back.
• Fever.
• Nausea and vomiting.
• Swollen and tender belly.
• Rapid pulse.

​Read more:​ Foods to Avoid If You Have Pancreatitis

ACG says you should let your doctor know if you have severe mid-abdominal pain or if you have milder pain that keeps coming back, or lasts for more than two weeks. Other reasons to call your doctor include:

• Frequent vomiting.
• Any blood in your vomit.
• Loss of appetite or weight loss.
• Bloody stools or stools that are black or tarry.
• Difficulty swallowing.

Diagnosis of epigastric pain may include imaging studies of your abdomen. Your doctor may also order blood, breath or stool testing. An endoscopic exam, with a long, thin, lighted scope and camera, is often done if you need to see a gastroenterology specialist. Treatment depends on the cause of your pain, says ACG.

There are many causes of mid-abdominal pain. ACG adds peptic ulcer disease and abdominal cancer as other possible causes. You should also know that chest pain from a heart attack can sometimes be mistaken for epigastric pain.

Call 911 if you have epigastric pain along with difficulty breathing, sweating, and pain the moves to your jaw, neck or arm.