Associated symptoms depend on what supports the onset of pain: for example, patients with epigastric pain from myocardial infarction may complain of widespread painful sensation in the shoulder and / or arm, wheezing, rattles when breathing, etc.
Correct diagnosis of the causes of epigastric pain is essential for planning the most appropriate therapy.
In anatomical language, the term epigastrium (or epigastric region) identifies the highest and central area of the abdomen, bounded above by the costal cartilages and below by the umbilical region.
ANATOMY OF THE EPIGASTRY
The epigastrium represents one of the nine anatomical regions with which doctors describe the "abdomen of the human being. Proceeding from left to right and from top to bottom, the other eight sections are: right hypochondrium, left hypochondrium, right lumbar region , umbilical region, left lumbar region, right iliac fossa, hypogastrium and left iliac fossa.
The epigastrium is located between the right and left hypochondrium.
Below the epigastric region, there are several internal organs, including:
- The pylorus. It is the terminal part of the stomach, responsible for regulating the introduction of gastric contents into the small intestine (ie the first part of the intestine). A valve, known as the pyloric sphincter, ensures an accurate passage of food between the stomach and intestines.
- The duodenum. It is the first part of the "small intestine; the latter" also includes the jejunum and the ileum.
- Pancreas
- Part of the liver
- Part of the aorta
- Part of the inferior vena cava
- Transverse colon. It is the third section of the large intestine (or large intestine); it follows the cecum and the ascending colon, while it precedes the descending colon, the sigma and the rectum. The transverse colon is also the uppermost part of the large intestine.
Epigastric pain is a symptom, therefore the consequence of a certain behavior or a specific morbid condition.
In most cases, it can be caused by:
- An excessive meal. This can lead to indigestion (or dyspepsia).
- Drink alcoholic beverages while dining.
- Consume large amounts of fatty or spicy foods.
- Gastroesophageal reflux disease. It consists in the excessive and chronic ascent towards the esophagus of the acid content of the stomach (gastric juices). The esophagus is the channel that connects the mouth to the stomach; the frequent presence, inside, of acidic substances coming from the stomach inflames the mucous walls and, subsequently, causes wear and tear.
- The presence of gastritis. It is the inflammation of the gastric wall, ie the inner wall of the stomach.
- A form of lactose intolerance. Lactose is the sugar found in milk and its derivatives. L "lactose intolerance is a condition in which the consumption of milk and its derivatives causes a non-allergic reaction, characterized by gastrointestinal disorders such as bloating, cramps and diarrhea.
- The state of pregnancy. In pregnant women, the onset of epigastric pain may be due to two reasons: a slowing down of the digestive process, induced by hormonal changes that characterize gestation, or an "increased pressure in the abdominal level by the growing fetus.
- The assumption of some gastric-damaging drugs, such as the so-called non-steroidal anti-inflammatory drugs (NSAIDs). Aspirin is an NSAID which, among its side effects, also presents epigastric pain.
LESS COMMON CAUSES OF EPIGASTRIC PAIN
Although more rarely, epigastric pain can arise due to:
- Barrett's esophagus. In those affected, a particular process is triggered that induces the replacement of the normal lining tissue of the esophagus with a tissue very similar to that which lines the duodenum. Barrett's esophagus predisposes to tumor of the esophagus (or esophageal tumor ).
- Gallstones in the biliary tract (or gallbladder stones). They are "pebbles" that form inside the gallbladder (or gallbladder), a saccular organ located under the liver and responsible for containing bile. The formation of gallstones in the biliary tract is due to the precipitation of the substances that make up the bile ( in particular, cholesterol and bile pigments).
Bile is a substance produced by the liver, which serves for the digestion and absorption of fats. - Hiatal hernia. The hiatal hernia is the protrusion of the stomach through the so-called esophageal diaphragmatic hiatus, that is the hole in the diaphragm into which the esophagus usually inserts.
According to a recent statistic, the hiatal hernia affects 15% of Italians. - Cancer of the pancreas. It is one of the malignant tumors with the poorest prognosis. Unfortunately, the low presence of symptoms in the initial phase must also be added to the high mortality, which greatly reduces the chances of an early diagnosis.
- Pancreatitis. It is the medical term for inflammation of the pancreas. There are forms of acute pancreatitis and forms of chronic pancreatitis.
- Peptic ulcer or perforated peptic ulcer.Peptic ulcers are small, well-localized lesions that affect the mucosa of the digestive system exposed to the action of gastric juices. They can therefore have various sites: stomach (gastric ulcer), duodenum (duodenal ulcer) and lower part of the esophagus (esophageal ulcer).
Peptic ulcers are defined as perforated when the lesions that characterize them are very deep, so much so that there is involvement of the blood vessels (haemorrhages). - Stomach cancer. In 90% of cases, stomach cancer (or stomach cancer) originates from the mucosal cells that form the inner wall of the stomach and from the glands between these cells.
This malignant neoplasm generally affects men over the age of 55, smokers and with poor eating habits (smoked foods, few fruit and few vegetables). - Cancer of the esophagus. Also known as cancer of the esophagus, it usually originates from the cells that line the inner surface of the esophageal duct. It is a very aggressive malignant neoplasm.
EPIGASTRIC PAIN OF CARDIAC NATURE
At approximately the same frequency as in previous cases, epigastric pain can be related to heart problems, particularly angina pectoris and myocardial infarction (or heart attack).
What are angina pectoris and myocardial infarction?
Angina pectoris is a syndrome characterized mainly by oppressive and constricting pain in the center of the chest. Its appearance is the result of a reduction in the blood supply to the heart, compared to what is necessary for its complete functionality. Generally, the reduced blood supply to the myocardium (ie the heart muscle) is due to a process of atherosclerosis that affects the coronary arteries.
Angina pectoris is a condition that typically occurs under stress, when, in the face of an "increased demand for blood from the heart, there is" no "adequate response in terms of perfusion.
Heart attack, on the other hand, is a much more serious condition than angina pectoris. In those affected by a myocardial infarction, the blood supply to the heart is reduced to the point that a more or less extended portion of the heart muscle undergoes necrosis (ie death). Moreover, without the right blood supply, they lack oxygen and nutrients, essential elements for the survival of any cell in the body.
WHEN PAIN IS ASSOCIATED WITH HEART PROBLEMS
When epigastric pain is related to heart problems, such as angina pectoris or myocardial infarction, the symptoms that may accompany its presence are:
- Chest pain of constricting and oppressive type
- Palpitations
- Diffuse pain also in the shoulder and left arm
- Breathing problems, including wheezing (shortness of breath), difficulty in deep breathing, wheezing when breathing, and choking
- Vomiting with blood or black substance such as coffee grounds
COMPLICATIONS
It is not so much the epigastric pain per se that establishes a certain pattern of complications, but rather the causes that caused it to appear.
For example, in the case of stomach cancer, a possible complication of this disease is the spread of cancer cells to adjacent organs and metastasization (the process by which cancer cells spread to other parts of the body through the bloodstream).
Even when it is not associated with particularly serious pathologies, persistent epigastric pain can be very annoying and affect the standard of living of those affected.
WHEN TO SEE THE DOCTOR?
It is good to consult a doctor, or go to the nearest hospital, if the epigastric pain is persistent, annoying and / or associated with symptoms that can be traced back to some serious medical condition.
Symptoms and signs in the presence of which an immediate medical consultation is recommended.
- Painful sensation of a constricting-oppressive type, which spreads from the epigastrium to the whole chest, shoulder and arm.
- Nausea with vomiting.
- Vomiting with blood or black substance.
- Respiratory problems.
The most serious pathologies with a potentially poor prognosis, which cause epigastric pain.
- Stomach cancer
- Cancer of the esophagus
- Cancer of the pancreas
- Angina pectoris
- Myocardial infarction
