Epigastric pain refers to pain or discomfort below the ribs in your upper abdomen area. Causes range from acute digestive issues like acid reflux to chronic conditions such as esophagitis.

Epigastric pain is a term to describe discomfort or aching that occurs beneath your rib cage in your upper abdominal region.

It has many causes, including overeating, lactose intolerance, and underlying conditions like gastroesophageal reflux disease (GERD), inflammation, and infection.

Knowing what’s causing your epigastric pain is important so you can work with a doctor to treat it.

Keep reading to learn more about what may be causing your symptoms.

Potential causes of epigastric pain include:

1. Acid reflux and heartburn

Acid reflux is when some of the acid or food in your stomach washes back up into your esophagus. If you experience frequent acid reflux, you may have a condition known as GERD.

Heartburn is a symptom of acid reflux and GERD, commonly described as a burning feeling in your chest after you eat. This feeling is usually worse when you lie or bend down due to the position of your esophagus.

2. Lactose intolerance

Lactose intolerance happens when your body has trouble digesting dairy products, such as milk or cheese. Typically, symptoms will occur every time you eat dairy.

Dairy products contain a type of sugar called lactose. Lactose intolerance often develops when you don’t have enough lactase enzyme. This enzyme is important in breaking down lactose. Learn more about the symptoms of lactose intolerance.

Although lactose intolerance may cause epigastric pain, it’s usually felt lower down in the abdominal area.

3. Overeating

When you eat too much in one go, your stomach can expand beyond its usual size. This puts a lot of pressure on the organs around it. This pressure can cause pain in your gut and lead to indigestion (dyspepsia).

Symptoms may include heartburn due to stomach acid and contents returning to your esophagus.

4. Hiatal hernia

A hiatal hernia happens when part of your stomach gets pushed up toward your diaphragm through the hole that the esophagus passes through, which is called the hiatus.

Hiatal hernias don’t always cause pain or discomfort. However, they may lead to acid reflux or GERD, which can cause epigastric pain or heartburn.

Learn more about the symptoms of a hiatal hernia.

5. Esophagitis

Esophagitis occurs when the lining of your esophagus becomes inflamed.

Common causes include:

  • acid coming back up from your stomach
  • allergies
  • infection
  • chronic irritation from medications

6. Gastritis

Gastritis happens when the lining of your stomach (mucosa) becomes inflamed. This may be due to a bacterial infection, an immune system disorder, or ongoing damage to your stomach.

It can be acute, last briefly, or chronic, lasting for years or more if left untreated.

Learn more about the symptoms of gastritis.

7. Peptic ulcer disease

Peptic ulcer disease happens when the lining of your stomach or small intestine gets damaged a bacterial infection or by certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs).

8. Barrett’s esophagus

Barrett’s esophagus occurs when the tissue that lines your esophagus becomes more like the tissue lining your intestines. This is known as intestinal metaplasia.

This condition may result from acid reflux, which can cause epigastric pain. However, not everyone with Barrett’s esophagus will have acid reflux.

If you develop this condition, you’ll need to work closely with your doctor to manage symptoms. Untreated Barrett’s esophagus can increase your chances of cancer of the esophagus.

Learn more about Barrett’s esophagus.

9. Gallbladder inflammation or gallstones

Your gallbladder can become inflamed when gallstones block the opening of this organ. The condition is known as cholecystitis.

This can be painful and may require hospitalization or surgery.

10. Epigastric pain in pregnancy

Mild epigastric pain is common while you’re pregnant due to the pressure on your abdominal area, as well as changes in your hormones, affecting digestion.

However, significant epigastric pain in pregnancy is sometimes a symptom of a serious condition known as preeclampsia. You’ll want to work closely with your doctor, as this can become life threatening if severe.

Learn more about the symptoms of preeclampsia.

11. Coronary artery disease

Coronary artery disease (CAD), also called ischemic heart disease, can present with what may feel like gastrointestinal symptoms, including abdominal pain. This is particularly common in women.

If you have concerns that this may be the cause, it’s important to seek advice from a doctor.

12. Enlarged spleen

The spleen is a vital part of your immune system, located on the left side of your body beneath the rib cage. Various conditions or diseases can lead to an enlarged spleen.

If it isn’t treated promptly, it can rupture, which can be life threatening.

Not everyone with an enlarged spleen will experience symptoms, but it can feel like a pain in the abdomen where the spleen is located.

Learn more about an enlarged spleen.

Treatment for epigastric pain depends on the cause. If your pain is from your diet or overeating, your doctor may recommend changing your eating habits or lifestyle. This may include taking regular exercise and eating nutrient-dense foods that don’t upset your stomach.

If the pain is from certain medications, such as NSAIDs, your doctor may help you find another way to manage your pain. They may also suggest antacids or acid-blocking medications to relieve your symptoms.

If an underlying condition such as GERD, Barrett’s esophagus, or peptic ulcer disease is causing your epigastric pain, you’ll likely require acid-blocking medications. You may also require antibiotics if a bacterial infection is involved (for example, if your ulcer disease is due to H. pylori).

Reach out to your doctor immediately if your epigastric pain is severe, ongoing, or interfering with your daily life.

Since there are life threatening conditions that can present with epigastric pain, such as CAD, it’s important you go to the emergency room if you have any of the following symptoms:

  • trouble breathing or swallowing
  • throwing up blood
  • blood in your stool or black, tarry stool
  • high fever
  • chest pain
  • difficulty breathing
  • passing out

You should also contact your doctor if your symptoms do not improve with over-the-counter or home treatments and have lasted more than a few days.

Epigastric pain is a term used to describe pain or discomfort located beneath the ribcage in your upper abdomen. It can have various causes, many associated with the digestive system.

Epigastric pain has a range of causes, some more severe than others. If your symptoms do not improve or you experience severe symptoms, contact a healthcare professional to find out the cause.

Contacting your doctor as soon as you notice persistent epigastric pain can help you find relief for your symptoms.