Many conditions affecting an array of different organs and structures can cause pain in the upper stomach, or abdomen. Medical conditions that trigger this symptom vary from relatively mild ailments to potentially life-threatening disorders. Fortunately, common causes of upper abdominal pain tend to be the less serious than more rare causes. The nature, location, intensity, frequency and timing of the pain as well as accompanying signs and symptoms help narrow the list of potential causes of upper abdominal pain.

Is This an Emergency?

If you are experiencing serious medical symptoms, seek emergency treatment immediately.

Stomach and Esophagus Ailments

Inflammation of the stomach lining, or gastritis, commonly causes gnawing or burning pain in the right or middle upper abdomen. Other possible symptoms include reduced appetite, nausea, vomiting and hiccoughs. The condition often develops due to a stomach infection with H. pylori bacteria, excess alcohol consumption, or frequent use of nonsteroidal anti-inflammatory medicines, such as aspirin or ibuprofen (Advil, Motrin). Stomach ulcers often cause symptoms similar to those of gastritis, and share the same risk factors.

Inflammation of the esophageal lining, or esophagitis, also frequently causes upper abdominal pain -- typically just below the breastbone. Reflux of stomach contents into the esophagus is frequently to blame, causing heartburn. Infections of esophagus generally cause more severe, persistent burning pain that often extends upward into the chest. These infections most often occur in people with a weakened immune system.

Gallbladder and Liver Disorders

A variety of liver disorders can cause right upper abdominal pain. Liver inflammation, or hepatitis, often provokes mild to moderate pain -- especially if the condition evolves rapidly, or acutely. Common causes of hepatitis include viral infections, alcohol abuse, and toxic overdoses of medications or herbs. Other possible symptoms include:

  • fatigue
  • loss of appetite
  • nausea
  • vomiting
  • dark urine
  • yellow discoloration of the skin

Intestinal Ailments

A wide variety of ailments affecting the small or large intestine can cause upper abdominal pain. Ulcers of the first section of the small intestine, or duodenum, are common. They cause pain and symptoms virtually identical to stomach ulcers. Other intestinal ailments that might cause:

  • upper abdominal pain include irritable bowel syndrome (IBS)
  • diverticulitis
  • Crohn disease
  • colon obstruction
  • early appendicitis,
  • impaired blood flow to the bowel
  • a condition called mesenteric ischemia

These disorders can cause pain in different areas of abdomen 2. Accompanying signs and symptoms vary, depending on the intestinal condition.

Pancreas and Spleen Disorders

Inflammation of the pancreas, or pancreatitis, typically causes pain in the upper abdomen that often radiates to the back. Acute pancreatitis pain is usually more severe than that associated with chronic pancreatitis. Other symptoms may include:

  • bloating
  • nausea
  • vomiting
  • weight loss
  • fatty stools
  • fever

Pancreatitis risk factors include excess alcohol consumption, gallstones, smoking and cystic fibrosis.

Other Causes

A number of other medical conditions can provoke upper abdominal pain, although discomfort in this location might be atypical with some of these ailments. Doctors typically turn their attention to these less frequent causes after more common conditions have been ruled out. A partial list of less frequent causes of upper abdominal pain includes: -- heart attack -- lower lobe pneumonia -- blood clot of the lung, or pulmonary embolism -- kidney infection or stone -- rupture or dissection of the aorta -- ectopic pregnancy -- abdominal infection or abscess -- diabetic ketoacidosis -- musculoskeletal conditions of the abdominal wall -- tumors of the digestive system, kidney, pancreas or spleen

Warnings and Precautions

See your doctor if you experience unexplained persistent or recurring upper abdominal pain. Seek emergency medical care if your pain is severe or increasing, or if it is accompanied by any warning signs or symptoms, including: -- fever or chills -- rapid breathing or shortness of breath -- dizziness, lightheadedness or fainting -- agitation, irritability or confusion -- rapid or pounding heartbeat -- persistent vomiting -- vomiting blood or material the resembles coffee grounds or has a stool-like odor -- bloody, maroon or black stools

Reviewed and revised by: Tina M. St. John, M.D.

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