Epigastric pain

For a lay person:

Epigastric pain is pain in the upper middle part of the abdomen, just below the breastbone. It can feel burning, gnawing, aching or full, and is often linked to eating. Common causes include indigestion, gastritis, reflux and stomach ulcers.

For a trained medical person:

Differential diagnosis includes functional dyspepsia, gastritis, peptic ulcer disease (H. pylori, NSAIDs), GERD, biliary disease, pancreatitis and, importantly, myocardial ischaemia. Alarm features — age over 55 with new symptoms, weight loss, dysphagia, persistent vomiting, GI bleeding, anaemia — mandate endoscopy.

In Chinese medicine:

Classed as stomach pain (胃痛). Patterns include Cold invading the Stomach, Retention of Food, Liver Qi invading the Stomach, Stomach Heat or Fire, Damp-Heat, Blood Stasis in the Stomach, Stomach Yin Deficiency, and Stomach and Spleen Deficiency with Cold.

When to get help: Get emergency care for pain spreading to the chest, jaw or arm, vomiting blood, black stools, or sudden severe pain.