Epigastric Discomfort | Back Pain, Vomiting, Headache, Diarrhea, and Other Associated Symptoms

“When You Feel Epigastric Discomfort, How to Infer the True Cause from Accompanying Symptoms”

Hello. This is Baengnokdam Korean Medicine Clinic.

Do you often experience a feeling of discomfort in your epigastric region?

It might feel like simple indigestion, or a constant urge to burp without actually burping. Sometimes, it can even be accompanied by back pain or a choking sensation.

A single symptom like epigastric discomfort can hide completely different pathologies and causes. So today, I'll explain the underlying situations, categorized by patterns, focusing on "epigastric discomfort + accompanying symptoms."

1. If Accompanied by Vomiting or Nausea?

If you feel epigastric discomfort right after a meal, followed by immediate retching and nausea, you should first consider the possibility of impaired gastric emptying. When food remains in the stomach for an extended period, it stimulates the vagus nerve, causing nausea and a feeling of vomiting. This often leads to abdominal bloating and post-meal fatigue.

2. If Accompanied by Back Pain?

If epigastric discomfort is accompanied by a stiff or dull aching sensation in the back, you should suspect irritation of the pancreas, duodenum, or posterior wall of the stomach. Particularly, if back pain occurs after meals, or if you wake up at night with a stiff back, the possibility of early pancreatitis or retroperitoneal irritation cannot be ruled out.

3. If You Have Heartburn?

If you experience a burning sensation, along with burping and a bitter taste rising up, it is highly likely to be gastric acid reflux (GERD) or excessive stomach acid. If the pattern involves a burning pain in the epigastric region that worsens when lying down and improves when sitting upright, you should definitely consider the possibility of reflux esophagitis.

4. If Diarrhea is Recurrent?

If epigastric discomfort is immediately followed by recurrent diarrhea, it could be a disturbance of the autonomic nervous system, particularly a gastrointestinal response to stress. If you frequently say things like, "My stomach gets upset and I need to go to the bathroom often whenever I'm stressed," or "I get sudden abdominal pain right after eating," it often indicates an overlap of functional gastrointestinal disorder and IBS.

5. If You Feel Shortness of Breath or Difficulty Breathing?

If epigastric discomfort feels like a blockage, accompanied by difficulty breathing, it could be due to gastric distension compressing the diaphragm, or psychogenic hyperventilation, which is an early form of a panic attack. Especially if these symptoms only occur after meals, try abdominal breathing or sitting upright to see if the symptoms subside.

6. If You Experience Heart Palpitations?

If epigastric discomfort is accompanied by a rapid heartbeat or a tightening sensation in the chest, it may indicate an imbalance in the autonomic nervous system. If these symptoms persist despite basic tests like an electrocardiogram showing no abnormalities, it could be a 'functional disorder' where the body's responsiveness has become overly sensitive.

7. When You Feel a Persistent Urge to Burp but Cannot?

When burping is recurrent or you feel a constant urge to burp without relief, accompanied by discomfort, it may indicate a failure of gastric fundus relaxation or gastric air distension. If you say, "My stomach feels full, but I haven't eaten anything," or "I constantly feel gassy," then addressing habits like aerophagia (air swallowing) or dietary changes is important.

8. Epigastric Discomfort Even on an Empty Stomach?

If, even on an empty stomach, you experience a feeling of emptiness or an unpleasant pressure in the epigastric region, along with an inexplicable heavy or nauseous sensation in your stomach, it could be a state of mental tension, gastrointestinal hypersensitivity, or the EPS type of functional dyspepsia. This often appears in stressful situations and is characterized by a recurring pattern that intensifies with psychological pressure.

So, to summarize, it's almost impossible to determine the cause based solely on the symptom of epigastric discomfort. Instead, by focusing on "what it accompanies," you can infer the true cause more accurately. If you are experiencing recurrent discomfort and accompanying symptoms, I encourage you to check them against the patterns discussed today. Thank you.

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