Stomach Pain

Stomach pain causes discomfort of varying intensity in the area of the body located between the sternum and the navel. Although it is usually caused by gastric disturbances, it may be a symptom of coronary or vascular conditions.

Symptoms and causes

Stomach pain refers to discomfort felt in the epigastrium, which is the body region extending from the end of the sternum to the navel. It may have diverse origins, ranging from mild conditions to severe disorders that pose a risk to the patient’s life.

Depending on its course, stomach pain may be acute (short duration) or chronic (persisting for several months). Based on its characteristics, it is classified as localized pain (in a specific area) or generalized pain (affecting a large portion of the abdomen).

The prognosis of stomach pain varies depending on the underlying cause, although in most cases it is benign in nature and resolves without complications. To rule out serious conditions, it is essential to consult a specialist when discomfort is persistent or accompanied by other severe symptoms.

Symptoms

Stomach pain manifests in the following ways:

Dull pain: constant, diffuse discomfort that is difficult to localize.
Burning or heartburn: a burning sensation in the upper abdomen or chest.
Cramps: severe, cramping muscular contractions.

Stomach pain is considered a medical emergency in the following cases:

Sudden onset of severe pain.
Mild pain that progressively worsens over hours.
Pain accompanied by:
- Fever above 38°C.
- Persistent vomiting.
- Vomiting or stools containing blood.
- Rigid abdomen.
- Dizziness or fainting.
- Cold sweating.
Stomach pain during pregnancy.
Pain following an accident or trauma.

Causes

Stomach pain may have a wide variety of causes. Some of the most common include:

Gastroenteritis: inflammation of the lining of the stomach and intestines.
Gas: accumulation of air in the stomach due to rapid eating, chewing gum, smoking, or the accumulation of unfermented food.
Dyspepsia: commonly known as indigestion; discomfort caused by overeating or consuming alcohol, coffee, or fatty and spicy foods.
Gastritis: inflammation and irritation of the gastric mucosa (stomach lining).
Food poisoning: ingestion of food or beverages contaminated with chemicals, parasites, bacteria, or viruses.
Food intolerance: adverse reaction to food when the digestive system cannot properly break it down. It is usually due to enzyme deficiency and is not related to immune system activity.
Food allergies: immune system reaction to a food that the body identifies as harmful, although it is usually harmless.
Constipation: excessively slow movement of stool through the intestinal tract, characterized by fewer than three bowel movements per week with dry, hard stools.
Gastroesophageal reflux disease: stomach contents rise from the stomach into the esophagus.
Appendicitis: inflammation of the appendix.
Peptic ulcer: an open sore in the lining of the stomach.
Abdominal aortic aneurysm: dilation of the lower part of the aorta, ending at the level of the navel.
Cholecystitis: inflammation of the gallbladder.
Myocardial infarction: blockage of blood flow to the heart.
Intestinal obstruction: partial or total blockage of the intestine that prevents the normal passage of food and gas.
Mesenteric ischemia: obstruction of blood flow in the intestine.
Kidney stones: formation of stones in the kidneys.
Peritonitis: inflammation of the membrane lining the abdominal cavity.
Internal bleeding: rupture of a blood vessel causing bleeding within the body.
Stomach cancer.
Pancreatic cancer.
Small intestine cancer.

Risk Factors

In addition to having diseases in which stomach pain is a symptom, the risk of experiencing this type of discomfort is higher in the following cases:

Poorly balanced diet rich in fatty or heavily seasoned foods.
Eating too quickly.
Smoking: in addition to promoting air intake into the stomach, nicotine relaxes the lower esophageal sphincter, increasing the likelihood of gastroesophageal reflux.
Excessive alcohol consumption.
Pregnancy: hormonal changes relax digestive muscles, and physical pressure from uterine growth compresses the stomach.
Obesity: excess abdominal fat exerts constant pressure on the stomach.
Stress.
Anxiety.
Medications: prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Complications

Complications of stomach pain depend on the underlying condition. Some of the most common include:

Dehydration: when discomfort is accompanied by vomiting or diarrhea.
Excessive weight loss.
Metastasis, in cases of cancer.
In extreme cases, death.

Which doctor treats stomach pain?

Stomach pain is most commonly managed within the specialties of General and digestive system surgery, Gastroenterology, or Family and community medicine. It may also require evaluation in Cardiology, Allergology, or Angiology and Vascular Surgery.

Diagnosis

The diagnosis of the causes of stomach pain requires different approaches depending on associated symptoms and the suspected disease. The most common procedures include:

Medical history: collection of information on medical history, lifestyle habits, and general health.
Physical examination: palpation of the abdomen to detect masses, inflammation, or rigidity, as well as identification of pain points.
Blood and urine tests: provide information on possible infectious or inflammatory processes, endocrine alterations, or liver disorders.
Stool analysis: the presence of blood in stools indicates possible gastrointestinal bleeding.
Imaging tests: allow visualization of internal structures.
- Ultrasound: uses sound waves to obtain real-time images; commonly used to diagnose appendicitis or kidney stones.
- Computed tomography (CT): X-rays are emitted from multiple angles to create a three-dimensional image; useful for diagnosing appendicitis or cancerous tumors.
- X-ray: uses X-rays to obtain a flat representation of the abdomen; commonly used to diagnose intestinal obstructions.
Endoscopy: a flexible tube with a camera is inserted through the mouth and gently advanced to the stomach to observe the condition of digestive system structures.

Treatment

Stomach pain improves with dietary changes. Although this does not influence the time required for the underlying condition to resolve, patients experience milder symptoms when avoiding spicy foods, seasonings, or coffee. It is also recommended to avoid large meals and to limit the time spent eating them.

Symptoms also improve with smoking cessation, as tobacco increases gastric acid secretion and reduces the secretion of bicarbonate, mucus, and prostaglandins responsible for neutralizing acid and protecting the gastric epithelial surface. Additionally, it reduces blood flow, thereby impairing proper function.

In addition to general recommendations, each condition associated with stomach pain requires specific treatment:

Gastroenteritis: resume solid food intake once liquids are tolerated, followed by a bland diet with gradual food reintroduction.
Gas: eat slowly, avoid chewing gum, do not smoke, and reduce intake of carbonated beverages and certain foods such as broccoli, cauliflower, legumes, or artificial sweeteners.
Dyspepsia: eat 5–6 small meals per day, chew slowly, wait before lying down after meals, and avoid gas-producing foods. Gastric protectants or antacids may be required.
Gastritis: in addition to a bland diet, proton pump inhibitors, H2 antagonists, or antacids are administered. If Helicobacter pylori is detected, antibiotics are prescribed.
Food poisoning: fluid replacement is essential to prevent dehydration; antibiotics or antiparasitics may be prescribed when indicated.
Food intolerance: elimination of trigger foods is the main strategy; in severe cases, antibiotics or probiotics may be used to restore intestinal flora balance.
Food allergies: in addition to avoiding trigger foods, antihistamines are used for mild symptoms and epinephrine (adrenaline) for severe reactions.
Constipation: increased intake of water and natural juices, 25–30 grams of daily fiber (fruit, vegetables, whole grains, legumes), and regular physical activity improve symptoms.
Gastroesophageal reflux disease: symptoms improve with weight control, smoking cessation, and avoiding lying down immediately after eating. Proton pump inhibitors or H2 blockers are prescribed; severe cases may require surgery.
Appendicitis: surgical removal of the appendix is performed urgently to prevent rupture.
Peptic ulcer: gastric acid is reduced with medication; antibiotics may also be required. Rarely, surgery is necessary.
Abdominal aortic aneurysm: small aneurysms require monitoring; large ones are surgically repaired by reinforcing the vascular wall.
Cholecystitis: fasting, rehydration, analgesics, or antibiotics improve symptoms; gallstones are often removed surgically, and in severe cases, the gallbladder is removed.
Myocardial infarction: typically treated with anticoagulants, thrombolytics, beta-blockers, or antiplatelet agents. Arterial obstruction is managed with balloon angioplasty or coronary artery bypass.
Intestinal obstruction: partial obstruction may resolve with a low-fiber diet; persistent or complete obstruction requires surgery.
Mesenteric ischemia: surgery is required to remove the clot or widen the occluded vessel.
Kidney stones: may pass spontaneously; shock wave therapy may be used to fragment larger stones, or surgical removal may be necessary.
Peritonitis: treatment usually involves a combination of antibiotics and surgery to remove infected tissue.
Internal bleeding: severe cases require blood transfusion and surgery to repair the damaged vessel.
Cancer: usually requires combined treatment with chemotherapy, radiotherapy or immunotherapy, and surgery to remove tumor cells.