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Stomach pain is a common occurrence in every person’s life but it is important to differentiate what is meant by this term. It is not uncommon for most people to refer to abdominal pain in general as stomach pain. However, the stomach is a specific part of the gastrointestinal tract, a hollow muscular organ that lies between the esophagus (food pipe) and small intestine (small bowel). Therefore stomach pain in the true sense refers to pain in the stomach organ. In order to understand the location of the pain it is important to first identify the location of the stomach.
Stomach Pain Under Left Rib Cage
Most of the human stomach is tucked under the left rib cage. It is often mistaken that the abdominal cavity only starts where the ribs end. Since the stomach is known to be in the left upper quadrant (LUQ), it is thought to lie lower than its actual anatomical position. The abdominal cavity actually starts a short distance below the nipple and therefore the last few ribs actually protect the uppermost abdominal organs.
The stomach, spleen and left kidney in particular sit tucked under the left rib cage. Therefore pain emanating from the stomach will be felt in this region. However, stomach pain is not the only reason for discomfort in the left upper quadrant (LUQ) as the spleen, left kidney and even the base of the left lung may be the reason for pain. Similarly the heart and esophagus are other possible causes of stomach pain under the left rib cage.
Stomach Pain Problems
There are four main conditions that cause stomach pain. These problems are common in the general population but should not exclude other less frequently seen conditions as a possible cause of stomach pain.
Gastritis Pain
Gastritis is a condition where the stomach wall is inflamed. It causes a dull aching pain, often described as a gnawing ache. The pain tends to worsen when the stomach is empty and sometimes after eating. Most cases of gastritis are due to H.pylori (Helicobater pylori) bacteria infection and the overuse of medication such as NSAIDs (non-steroidal anti-inflammatory drugs).
Stomach Ulcer Pain
Stomach ulcers are open sores that form in the stomach wall. It is a common complication of gastritis and is often caused by the same factors as gastritis. The pain in stomach ulcers is typically sharper and penetrating in nature although it can mimic gastritis with a dull ache. Sometimes stomach ulcer pain can be very severe and excruciating. It tends to worsen when the stomach is empty or after eating as well.
Gastroenteritis Pain
Gastroenteritis is inflammation of the stomach and small intestine, often extending to the large intestine. It is an acute infection caused most commonly by viruses (stomach flu) and to a lesser extent by bacteria and protozoan parasites. The pain is typically dull and aching associated with severe nausea and vomiting. It is caused by eating contaminated food or drinking unclean water as well as through direct contact with others who are infected.
Other Causes of Stomach Pain
Less common causes of stomach pain includes :
- Stomach polyps
- Stomach cancer
- Bile reflux
- Delayed gastric emptying due to conditions like gastroparesis.
- Achlorhydria
Indigestion Pain
Also known as non-ulcer dyspepsia, this type of stomach pain is due to overeating (distension pain), excessive stomach muscle activity and alcohol consumption. However, the actual cause of indigestion is often not known and it is therefore referred to as functional dyspepsia. The pain is typically not severe as is the case with stomach ulcers and is usually accompanied by intense nausea and a bloated feeling.
Stomach Pain Symptoms
Stomach pain is a symptom. Many diseases can cause stomach pain and on its own it is difficult to identify a possible cause. Therefore other symptoms that accompany pain in the stomach and the findings of diagnostic investigation like a gastroscopy are needed to conclusively identify the cause. Assessing stomach pain by its modalities and concomitant symptoms are another helpful way of evaluating the underlying pathological cause.
Stomach pain after eating
Stomach pain after eating is usually associated with all four major stomach conditions – gastritis, stomach ulcers, gastroenteritis and dyspepsia. Food may aggravate the pain as it stimulates the production of stomach acids and strong muscle contractions. The stomach acid may further irritate the stomach wall which is already damaged or elicit muscle pain when the stomach muscles begin working. Stomach pain after eating may also be noticed at the other extreme when the stomach is empty after hours of not eating.
Burning stomach pain
The stomach produces copious amounts of gastric acid and digestive enzymes at the time of eating. This aids with chemical digestion of the food as the strong muscle contractions of the stomach wall mechanically breaks down the food. A burning stomach pain generally infers irritation of the stomach wall by acid. It is seen with gastritis, stomach ulcers and to a lesser extent with indigestion. When it is associated with heartburn, it may be due to a gastroesophageal reflux disease (GERD) or Zollinger-Ellison syndrome, and the pain is often emanating from the esophagus in these cases.
Stomach pain, nausea and vomiting
All stomach conditions tend to cause nausea but vomiting is only seen in certain instances. Any irritation of the upper gastrointestinal tract, including the esophagus and first half of the small intestine, elicits nausea. Vomiting with intense nausea and dull stomach pain is more likely with gastroenteritis. To a lesser extent it can occur with stomach ulcers, gastritis and indigestion. Stomach pain with nausea and vomiting up of fresh blood or dark coffee grounds (degraded blood) may be a sign of a bleeding stomach ulcer or erosive gastritis.
Stomach pain and gas
Stomach pain with gas in the upper gut is a common symptom. It happens to most people in life with no stomach problems and is often a result of indigestion (dyspepsia). Here the gas build up presents as excessive belching and a bloated sensation (feeling of fullness). There may be abdominal distension but gas itself is not the result of the increased girth of the abdomen. Gastroenteritis, gastritis and stomach ulcers may also contribute to increased gas and belching but it s rare where it is as excessive as in indigestion. H.pylori infection may contribute to a moderate increase in stomach pain with gas.
Stomach Pain Treatment
There is no specific treatment that can be prescribed for every case of stomach pain. First the cause of the stomach pain should be identified. It is possible that the pain is emanating from the esophagus or duodenum, lying before and after the stomach respectively. Due to its close proximity to other abdominal organs, the pain may not be associated with the gastrointestinal tract and all and could be splenic pain, left kidney pain, pancreatic pain, gallbladder pain or even liver pain. The bend of the transverse colon known as the splenic flexure is a site where gas may become trapped and is another possible cause of stomach pain under the left rib cage.
Despite the treatment for different causes of stomach pain varying, there are some measures that are useful in most cases where the problem lies in the stomach itself. These medication neutralize the stomach acid, reduce its production or speed up the emptying of the stomach contents.
- Antacids are common over-the-counter (OTC) tablets and emulsions that help to neutralize stomach acid for short period.
- Proton pump inhibitors and H2-blockers are two types of acid-suppressing drugs that decrease stomach acid production and secretion.
- Metoclopramide is a prokinetic drug that speeds up the exit of digested food out of the stomach.
It is important to note that stomach pain with dizziness needs to immediate medical attentions, particularly where there is chest pain, shortness of breath and excessive sweating. These symptoms may be due to a heart attack and not with any stomach of gastrointestinal problem.
She is a dedicated gastroenterologist, guides individuals to optimal digestive health. Her expertise ensures individuals enjoy a balanced and comfortable digestive system, contributing to overall well-being and vitality.
