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Upper abdominal (tummy) pain
Indigestion
H. pylori infection.
Cancer
Bloating
Vomiting
Bleeding
This is when pain is felt in an area above the belly button (umbilicus) and below the rib cage in the front of the body or just to the sides. Pain can be caused by many things that occur in the organs and structures in this region. The stomach is perhaps the best known structure in this region and ulcers are also well known but they are not the commonest cause of pain here. In fact the most likely cause of pain is the irritable bowel syndrome, or sometimes trapped wind in the stomach which usually gets there from swallowing air. As there is a large amount of bowel present in the region as well as stomach the irritable bowel syndrome will also cause pain here. If the pain has a burning nature it might be caused by reflux of acid into the gullet from the stomach (Gastro-oesophageal reflux -GORD). If the pain is also felt in the back it could be caused by duodenal ulcers or pancreatic disease. Sometimes GORD pain also goes to the back as can gall bladder disease.
This is a term usually used to describe upper tummy pain after eating and is most often caused by reflux of stomach juices and food into the gullet (often felt as a burning pain in the central chest – heart burn). Other causes include air swallowing which results in bloating of stomach, and rarely ulcers or soreness of the stomach lining - gastritis.
H.pylori (Helicobacter pylori) was discovered to be the cause of stomach irritation and ulcers in both the duodenum and stomach in the late 1980’s and antibiotics soon became one of the main treatments for this type of ulceration. Not all ulcers in this region are caused by H.pylori infection however, and other common causes include the Non-steroidal anti-inflammatory drugs like ibuprofen and indomethacin.
Gastric cancer, as in the case of all cancers, is caused by the abnormal growth off tissue which spreads from the site where it started and invades nearby structures and can spread to other parts of the body and grow there as a secondary tumour – what is called a metastasis. Some cancers are easily spotted and therefore tend to be diagnosed at an early stage, but gastric cancer is often quite advanced before it causes enough symptoms for the person to seek medical help. Despite significant improvements in the treatment of gastric cancer over the last 20 years, it continues to be a difficult cancer to treat especially if it has spread to other parts.
Distension of the stomach can cause a sensation of bloating which is usually noticed during or soon after a meal. Sometimes this occurs if the person has overeaten but other times they have swallowed a lot of air whilst eating and this then either passes up as a belch (eructation) or downwardly as and may cause intestinal bloating and wind (flatulence). Some patients have an oversensitive stomach and feel bloated even when their stomach is not particularly distended, this is a type of irritable bowel (or irritable stomach).
Vomiting is often a sign of an underlying problem with the stomach and in most cases if persistent should be investigated further. Gastric ulcers can cause vomiting as can obstructions to the outflow of food from the stomach. Gall bladder disease can result in vomiting as can appendicitis. Some patients have problems with the way the muscles in the stomach work and when this causes a delay in stomach emptying it can result in vomiting.
In rare cases patients who vomit will bring up blood in the vomitus, sometimes the vomit is made up entirely of blood and this can be understandably very troubling and frightening for the person. In almost all cases urgent medical help is required and the patient should be admitted to hospital for investigations. In most cases an urgent endoscopy will be performed by a gastroenterologist so that the cause of the bleeding can be identified and treatment given to stop the bleeding.