Epigastric pain: what it feels like and what to do

That burning or pressing pain just under your ribs is called epigastric pain. It can be a dull ache, a sharp stab, or a tightness that comes after eating. Because many organs sit in that area, the cause can be minor — like acid reflux — or serious — like pancreatitis or heart problems. Knowing what to watch for helps you get the right care fast.

Common causes you should know

Some causes are harmless and easy to treat. Heartburn and GERD happen when stomach acid irritates the esophagus. Gastritis and peptic ulcers are inflammation or sores in the stomach lining, often linked to H. pylori infection or long-term NSAID use. Acid-related pain often improves with antacids, smaller meals, and avoiding trigger foods.

Other causes need more attention. Acute pancreatitis makes the pain severe and constant, often with nausea and vomiting. Gallstones can cause sharp epigastric pain that radiates to the back or right shoulder blade. Rarely, heart-related chest pain can start under the ribs, so don’t ignore tightness or sweating with shortness of breath.

How doctors figure out the cause

Your doctor will ask when the pain started, what makes it better or worse, and any other symptoms like fever, vomiting, weight loss, or jaundice. Basic tests may include blood work (to check for inflammation or liver/pancreas problems), an abdominal ultrasound (great for gallstones), and an upper endoscopy (to inspect the stomach and esophagus). If infection is suspected, they may test for H. pylori. Severe or unclear cases can need CT scans or referral to a specialist.

Small changes at home often help while you wait for care. Eat smaller, bland meals and avoid spicy or fatty foods. Cut back on alcohol and stop NSAIDs like ibuprofen if you suspect they trigger the pain. Over-the-counter antacids or an H2 blocker can provide short-term relief, but persistent pain deserves professional review.

Watch for emergency signs: sudden severe pain, fainting, fever with abdominal pain, vomiting blood, black or bloody stools, difficulty breathing, or chest pressure. Any of these mean get emergency help now.

To make the next appointment useful, keep a quick log: when the pain starts, what you ate, how long it lasts, and any other symptoms. Bring a list of meds and supplements — some can cause or worsen stomach irritation.

Epigastric pain is common, and many causes respond well to treatment. Still, trust your instincts: if the pain is severe, new, or getting worse, see a clinician. Getting an accurate cause makes treatment faster and prevents complications.