Digestive Disorders > Symptoms

Upper abdominal pain

Dr. med. Andre Sommer

Dr. med. Andre Sommer

This text explains the most common causes of upper abdominal pain - right, left and in the middle. A doctor should be consulted in the case of serious symptoms!

If you have already tried everything but your upper abdominal pain just doesn't get any better, we have a tip for you: Try to get it under control with your diet. Check out our nutritional therapy program and find out more in a free initial consultation with our experts.

The upper abdomen is limited at the top by the costal arches and extends down to the level of the navel. The upper abdomen can also be divided in to the right, middle and left area. However, this division into areas, to which characteristic diseases are assigned below, is fluid and is therefore not to be regarded as absolute.

Upper abdominal pain is a very non-specific symptom, which is not due to a typical illness, but can have many different causes. A detailed description of various features of the upper abdominal pain is essential for a precise diagnosis by the doctor. These include:

  • Pain quality (e.g. burning, stinging, dull),
  • Occurrence (e.g. constant, seizure-like, before / after the meal)
  • Accompanying symptoms (e.g. diarrhea, constipation, mucus in the stool)

When can upper abdominal pain be particularly dangerous?

In many cases, the symptoms do not last long and are relatively harmless, but in some cases there may be a serious illness.

A doctor should be consulted as soon as possible for severe or repeated pain as well under the following circumstances:

  • With fever
  • If the pain was caused by an external injury
  • If the pain has been going on for several hours
  • If there are signs of dehydration

An urgent emergency exists under the following conditions:

  • Vomiting blood (hematemesis)
  • Tar stool / bloody stool
  • Difficulty breathing
  • During pregnancy

In such cases, immediate medical treatment is necessary!

Pain in the right abdomen

Gall bladder and bile duct

Pain in the right upper abdomen is commonly due to gallstones in the biliary tract (cholelithiasis). Gallstones are solid waste products of the bile, the formation of which is promoted by high blood fat levels and being overweight. About three quarters of gallstone carriers do not develop symptoms and do not need therapy, but the stones may enter the bile duct and prevent the bile from being released into the intestine, which can trigger biliary colic.

In biliary colic, the bile duct muscles contract like a spasm, because the secretion of the bile is hindered by the gall stone. The sudden pain that occurs as a result is often described by those affected as stabbing and can radiate into the right shoulder and back. In particular, high-fat meals and alcohol consumption can cause these symptoms, since the bile is released more intensively after eating in order to digest the food. Therefore, in the case of biliary colic, it is not advisable to consume food or drinks containing calories!

Gallstones can also be the cause of an inflammation of the gallbladder (cholecystitis). Repeated relocation of the bile duct builds up the bile secretion in the gallbladder and leads to an inflammatory change in the gallbladder wall. The pain - like biliary colic - is spasm-like and is often accompanied by general symptoms such as fever and nausea. Since an inflamed gallbladder can create a hole in the wall and can have serious consequences, the gallbladder is usually surgically removed.

Liver

Another organ that is located in the right upper abdomen and can cause pain in this area is the liver. Liver diseases such as inflammation of the liver, cirrhosis of the liver or liver cancer are usually not associated with pain in the upper abdomen. However, the liver is covered by a crude capsule and it is possible that with these diseases the liver swells and exerts a strong pull on the capsule, which can cause enormous pain.

Pain in the left abdomen

Pain in the left upper abdomen is less common, but can indicate life-threatening illnesses.

Spleen

Diseases of the spleen are most often responsible for left-sided upper abdominal pain. After a traumatic event (e.g. a bicycle accident), the spleen can be torn open (rupture) and possibly cause potentially life-threatening bleeding. There are also splenic diseases that occur particularly frequently in children: A certain form of blood cancer (Chronic myeloid leukemia) or an infection by the Epstein-Barr virus (Whistling glandular fever) can cause the spleen to swell and the splenic capsule to stretch, causing severe pain.

Side stitches

It is not uncommon for stinging pain to be felt in the area of the left or right flank immediately after eating. These are usually simple side stitches that do not indicate disease. The causes have not been finally clarified, but the currently most credible explanatory approach attributes side stitches to the redistribution of blood: The liver and spleen are both organs that have reduced blood flow during physical exertion. But if food is consumed shortly beforehand, blood circulation is increased and the organs swell. The resulting stretching of the organ capsules causes pain when moving.

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Pain in the middle abdomen

Stomach

In healthy people, on the one hand, sufficient stomach acid is released into the stomach, but on the other hand, a protective layer of mucus is built up, which protects the stomach cells from the stomach acid. If the relationship between these two parameters becomes unbalanced and either excess acid is produced or the protective mucus layer is reduced, the gastric mucosa can be damaged. Smoking and alcohol consumption further promote this imbalance.

The gastric mucosa that has been damaged in this way is susceptible to infection by bacteria, for example Helicobacter pylori, which is the most common cause of gastritis. This in turn leads in many cases to a stomach ulcer - a local defect of the deep gastric mucosa. The pain caused by this typically increases when you lean forward or press on the upper abdomen.

The acidic stomach acid (pH 1-2), which favors the development of gastric mucosal inflammation and a gastric ulcer, is neutralized by the ingested food after meals and is then relatively harmless. On the other hand, stomach acid is increasingly produced several hours after the last meal, but this is not buffered and can irritate the stomach wall. The symptoms associated with gastric mucosal inflammation therefore often occur at night (“fasting pain”, “hunger pain”).

Analogous to irritable bowel syndrome, irritable stomach syndrome could be the cause of the symptoms. This syndrome includes a number of upper abdominal symptoms for which no organic cause can be found.

Therapeutically, a change in lifestyle and eating habits can help here, and psychotherapeutic measures are also a way to get the complaints under control.

Pancreas

The pancreas is an organ that releases important digestive enzymes into the intestine and thus plays an enormous role in the breakdown of food. For this very reason, the pain caused by the pancreas - similar to the gallbladder - occurs more after eating when the digestive enzymes are actively secreted. As a rule, the pain is in the middle to left upper abdomen and radiates like a belt up to the back. Those affected perceive it as a cutting or burning pain.

It is usually caused by an acute or chronic form of pancreatitis. In both forms of this condition, pain is often accompanied by nausea, vomiting, and weight loss. While acute pancreatitis is most often caused by a gallstone and can lead to potentially life-threatening self-digestion of the organ, long-term alcohol consumption is the main cause of chronic pancreatitis, which is mainly characterized by fatty, shiny diarrhea.

Heart

If there is severe pain in the upper abdomen, a possible cause in the heart should also be clarified, since stinging pain radiating into the upper abdomen can also be an indication of a heart attack.

What does upper abdominal pain mean with irritable bowel syndrome?

Finally, upper abdominal pain can also stem from the colon. There are a number of diseases of the large intestine that can cause pain, especially in the area of the right and left bowel bow (colon flexure), such as

  • Intestinal breakthrough (perforation)
  • Intestinal obstruction (ileus)
  • Intestinal narrowing (stenosis)
  • Colon cancer
  • Inflammatory bowel diseases (Crohn's disease, ulcerative colitis)

If these and other intestinal disorders and intolerances are excluded, irritable bowel syndrome may be present.

The symptoms of Irritable Bowel Syndrome are very diverse and, depending on the accompanying symptoms, can be divided into different forms: RDS-D (diarrhea), RDS-O (constipation), RDS-M (mixed type). However, all of these have in common that the abdominal pain is chronic-relapsing, i.e. the pain occurs again and again over a longer period of time: Phases with and without abdominal pain occur alternately.

With irritable bowel syndrome in particular, these abdominal pains are often not taken seriously and are attributed to psychological stress factors if no specific organic cause can be found. However, studies show that the importance of the psychological component is significantly less than expected - therefore, the often uncomplicated abdominal pain of irritable bowel syndrome should not be underestimated.

What if upper abdominal pain occurs after a meal?

In most cases, upper abdominal pain is largely harmless after meals: If too much food is ingested at once or too quickly, healthy people may experience bloating or mild abdominal pain. In addition, certain foods are tolerated better or worse depending on the individual. For example, high-fat milk and meat products are particularly difficult to digest and some vegetables such as cabbage and onions have a flatulent effect.

However, the fact that pain occurs after eating can also mean that there are problems in the digestive tract organs, which can make it difficult to either transport or decompose the food.

The following organs are mainly suspect here:

Esophagus

If gastric acid gets back into the esophagus through the opening in the stomach (reflux) and damages the wall of the esophagus, an inflammatory change can occur, which is accompanied by regular pain (heartburn) or even reflux esophagitis - especially after meals or at night. The pain typically ranges from the middle upper abdomen to the chest area.

Pancreas

(see above)

Gallbladder

(see above)

Our certified nutritionists can help you with the question of whether there is a connection between your meals and upper abdominal pain. Together with them we have developed a nutritional therapy with which many people have been able to alleviate their symptoms in the long term. Find out more about the program here and get more information in a free initial consultation.

Abdominal pain in pregnancy

If upper abdominal pain occurs during pregnancy, the cause must be clarified.

Pre-eclampsia

Pre-eclampsia is a disease that occurs in around 5 to 10 percent of pregnant women and can trigger a number of symptoms in the last three months of pregnancy: e.g. fluid retention, headache, fibrillation of the eyes and upper abdominal pain. Typically, blood pressure is increased and protein is excreted in the urine, which should normally be retained in the body.

If pre-eclampsia is not treated in time, the child's oxygen and nutrient supply may not be sufficient. As a result, growth disorders can occur, which can lead to a low birth weight.

HELLP syndrome

HELLP syndrome is a special form of pre-eclampsia, in which liver values also increase, the number of platelets decreases and the red blood cells are broken down more. This disease can be very dangerous and should be treated as soon as possible. Early birth of the child is often necessary to protect the mother and child.

Abdominal pain in children

There are two important points to consider in children:

Poor localization

Depending on their age, children can only specify the painful area more or less precisely. Therefore, the information provided by children should be interpreted very carefully!

Psychological causes

In addition, it can be expected that the abdominal pain is not of an organic nature. Children have a tendency to project psychological problems such as anxiety, stress or experiences of frustration onto abdominal pain. However, if in doubt, a pediatrician should be consulted to clarify other causes.

Niedergethmann, M. and Post, S., 2006. Differenzialdiagnose des Oberbauchschmerzes. Dtsch Arzteblatt, 103, pp.A862-71. Downloaded on 17.06.2016 form: https://www.aerzteblatt.de/pdf.asp?id=50809
Bufler, P., Groß, M. and Uhlig, H.H., 2011. Chronische Bauchschmerzen bei Kindern und Jugendlichen. Dtsch Arztebl Int, 108(17), pp.295-304. Downloaded on 17.06.2016 form: https://www.aerzteblatt.de/pdf/108/17/m295.pdf
Layer, P. and Rosien, U., mitherausgegeben von Brambs HJ, Ell C, Fischbach W, Groß MJ, Stolte M, Zirngibl H, Praktische Gastroenterologie. Downloaded on 17.06.2016 from: http://www.ik-h.de/fileadmin/mediapool/pdf/23372Layerchp01.pdf

Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara.

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