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Epigastric Pain

There can be many causes of central upper abdominal pain. It is important to tell your doctor about your symptoms. Common symptoms that occur with central upper abdomen pain indicate the pain might be from your digestive system include heartburn, difficulty swallowing, nausea, and vomiting. The best diagnostic imaging test to make a diagnosis is based on your symptoms. If acid reflux, esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach lining), or peptic or duodenal ulcer is suspected, a fluoroscopic imaging test of the esophagus (eg, esophagography) or esophagus, stomach, and duodenum (eg, upper gastrointestinal [GI] series) is usually appropriate. These tests use x-rays to see your digestive system with the help of safe-to-swallow contrast liquid or gas, including air, iodine, and barium. After fluoroscopic tests, CT of the abdomen and pelvis with or without intravenous (IV) contrast may also be appropriate.

If gastric (stomach) cancer is suspected by your doctor, both fluoroscopic upper GI series and abdominal and pelvic CT with IV contrast are usually appropriate. Abdominal and pelvic CT without IV contrast, abdominal CT without IV contrast, and multiphase abdominal CT with IV contrast may also be appropriate.

If a hiatal hernia (the upper part of the stomach pushes through the diaphragm into the chest) is suspected by your doctor, fluoroscopic esophagography with or without gas (eg, biphasic fluoroscopy or single-contrast esophagography) and upper GI series are usually appropriate.

— By Samantha Greben, BA, and Nicola Schieda, MD. This information originally appeared in the Journal of the American College of Radiology.

This page was reviewed on July 25, 2022

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