Stomach Pain: Complete Medical Guide to Causes, Diagnosis, and When to Seek Help

Introduction: Understanding Abdominal Pain and When It Matters

Stomach pain is one of the most common health concerns people experience, ranging from mild discomfort that resolves on its own to severe pain signaling a medical emergency. The challenge is distinguishing between temporary, self-limited pain and symptoms requiring immediate medical attention.

Many people assume that any abdominal discomfort originating in the upper abdomen is “stomach pain,” yet the anatomy is more complex. Multiple organs—the stomach, pancreas, liver, gallbladder, and intestines—occupy the upper abdominal cavity. Pain perceived as coming from the stomach might actually originate from any of these structures, each requiring different treatment approaches.

This comprehensive guide explains what stomach pain truly represents, the anatomy behind upper abdominal pain, the diverse causes ranging from benign to serious, how physicians diagnose the underlying problem, and both conventional and natural approaches to relief. Whether you’re experiencing occasional mild discomfort or recurring pain that affects your quality of life, this resource provides medical clarity to help you understand when self-care suffices and when professional evaluation is essential.

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Abdominal Anatomy: Where Is Your Pain Really Coming From?

The Regions of the Abdomen

The abdomen is conventionally divided into nine regions to help healthcare providers precisely locate pathology:

Upper Abdominal Regions (Where “Stomach Pain” Typically Occurs):

1. Epigastric Region (Central Upper Abdomen): The area directly below the ribs, above the umbilicus (belly button), corresponding roughly to the solar plexus

2. Right Upper Quadrant (RUQ): Upper right region beneath the rib cage

3. Left Upper Quadrant (LUQ): Upper left region beneath the rib cage

The term “stomach pain” typically refers to pain in the epigastric region, but pain here can originate from multiple organs.

Organs in the Upper Abdomen

The Stomach

Location: Upper left-center abdomen, just below the diaphragm and protected by the rib cage

Function:

• Receives food from the esophagus

• Secretes gastric acid and enzymes for food breakdown

• Churns food into a semi-liquid mixture (chyme)

• Regulates release of food into the small intestine

Pain Characteristics When Affected:

• Epigastric (upper center) discomfort

• May feel like burning, cramping, or aching

• Often related to eating (triggered by meals or occurring several hours after)

• May be accompanied by early satiety (feeling full quickly)

• Nausea common

The Pancreas

Location: Deep in the upper abdomen, behind the stomach, extending from left to right

Function:

• Produces digestive enzymes released into the small intestine

• Produces hormones (insulin, glucagon) for blood sugar regulation

• Produces bicarbonate to neutralize gastric acid

Pain Characteristics When Affected:

• Epigastric or left upper quadrant pain

• Often severe and persistent (not crampy)

• Typically radiates to the back

• Pain increases after eating, especially fatty foods

• Associated with nausea and vomiting

• May be accompanied by weight loss (in chronic pancreatitis)

The Liver

Location: Right upper abdomen, beneath the rib cage

Function:

• Produces bile for fat digestion

• Metabolizes nutrients and removes toxins

• Produces clotting factors and other proteins

• Stores glucose and vitamins

Pain Characteristics When Affected:

• Right upper quadrant pain

• Often described as dull ache

• May be accompanied by jaundice (yellowing of skin and eyes)

• Nausea, loss of appetite

• Right shoulder pain (referred pain from irritation of diaphragm)

The Gallbladder

Location: Right upper quadrant, tucked under the liver

Function:

• Stores and concentrates bile

• Releases bile into small intestine during fat digestion

• Regulates bile flow

Pain Characteristics When Affected:

• Right upper quadrant pain (classic location)

• Can radiate to epigastric region, right shoulder, or back (creating confusion with “stomach pain”)

• Sudden onset (biliary colic) or gradual (cholecystitis)

• Triggered by fatty meal

• May be accompanied by nausea/vomiting

• Right shoulder pain common

The Transverse Colon (Large Intestine)

Location: Passes horizontally across the upper abdomen, just below the stomach

Function:

• Absorbs water and electrolytes from stool

• Continues digestive process

• Houses beneficial bacteria

Pain Characteristics When Affected:

• Epigastric or upper abdominal cramping

• May be accompanied by diarrhea or constipation

• Bloating and gas

• Pain may be colicky (intermittent cramping)

The Spleen

Location: Left upper quadrant, beneath the rib cage

Function:

• Filters blood

• Stores blood cells

• Produces white blood cells for immunity

Pain Characteristics When Affected:

• Left upper quadrant pain

• May be acute (if enlarged suddenly) or chronic (if chronically enlarged)

• Left shoulder pain (referred pain)

• Pain with deep breathing

Understanding Referred Pain

An important concept in abdominal pain diagnosis is “referred pain”—pain felt in a location distant from the affected organ. This occurs because:

• Multiple organs share the same nerve pathways

• The brain may misinterpret the pain location

Common Referred Pain Patterns:

• Gallbladder pain can radiate to the right shoulder or epigastric region

• Pancreatic pain radiates to the back

• Right-sided organ pain may refer to the right shoulder

• Diaphragm irritation causes shoulder pain (Kehr’s sign)

This is why physical examination alone may not reveal the diagnosis, and why imaging or specialized testing is often necessary.

Types and Causes of Stomach Pain: A Comprehensive Review

Classification by Pain Duration

Understanding how long you’ve experienced pain helps narrow the differential diagnosis.

Acute Stomach Pain (Sudden Onset, Days to Weeks)

Characteristics:

• Develops rapidly, often with clear onset

• Duration: Hours to days to weeks

• Often more severe than chronic pain

• May indicate need for urgent evaluation

Common Acute Causes:

1. Gastroenteritis (Stomach Flu)

Mechanism: Viral or bacterial infection of stomach and small intestine

Causative Organisms:

• Viruses: Norovirus, rotavirus, enteroviruses (most common viral causes)

• Bacteria: Salmonella, Shigella, Campylobacter, E. coli

• Parasites: Less common in developed countries

Symptoms:

• Acute onset cramping or generalized abdominal pain

• Diarrhea (sometimes bloody)

• Nausea and vomiting

• Fever (variable)

• Loss of appetite

• Dehydration

Duration: Typically 24-72 hours for viral; bacterial may last longer

Treatment:

• Fluid replacement (oral rehydration solutions preferred; IV if severe)

• Rest and dietary modifications (bland diet as tolerated)

• Antimotility agents (loperamide) usually avoided (may prolong infection)

• Antibiotics only if bacterial infection identified; not effective for viral

When Urgent: Severe dehydration, bloody stools, high fever, or symptoms lasting >7 days

2. Acute Gastritis

Mechanism: Acute inflammation of stomach lining

Causes:

• NSAID Use: Aspirin, ibuprofen, naproxen cause acute gastritis

• Alcohol: Binge drinking or chronic heavy use irritates stomach lining

• Stress: Physical stress (trauma, surgery, severe illness) causes stress gastritis

• Infection: H. pylori in early infection phase

• Food Triggers: Spicy foods, acidic foods, hot beverages

Symptoms:

• Epigastric pain or burning

• Nausea

• Anorexia (loss of appetite)

• Possible vomiting

• Dyspepsia (indigestion)

Treatment:

• Remove causative agent (stop NSAIDs, alcohol, trigger foods)

• Antacids for symptomatic relief

• H2 blockers or proton pump inhibitors (PPIs) if severe

• Bland diet

• Most cases resolve within days

3. Peptic Ulcer Disease (Acute Presentation)

Mechanism: Breach in the protective lining of stomach or duodenum (first part of small intestine)

Causes:

• Helicobacter pylori infection: Most common cause worldwide (responsible for 60-90% of ulcers)

• NSAID Use: Second most common cause (especially in older adults)

• Stress Ulcers: Occur during severe physiological stress

• Rare: Zollinger-Ellison syndrome (gastrin-producing tumor)

Symptoms:

• Epigastric pain or burning

• Pain often gnawing or hunger-like

• Occurs 1-3 hours after meals (gastric ulcers may be worse with food; duodenal ulcers improve with food)

• May awaken from sleep

• Nausea, loss of appetite

• Weight loss (if chronic)

Complications (Requiring Emergency Care):

• Perforation: Ulcer erodes through stomach wall; causes acute severe peritonitis (abdominal lining inflammation)

  • Presents with sudden severe epigastric pain, rigid abdomen, shock

  • Medical emergency; may require surgical repair

• Bleeding: Ulcer erodes blood vessel

  • Hematemesis (vomiting blood) or melena (black tarry stools)

  • May present with syncope (fainting) from blood loss

  • Medical emergency; requires transfusion and endoscopy

Diagnosis:

• H. pylori testing: Urea breath test, stool antigen test, serum antibodies, or endoscopic biopsy

• Endoscopy to visualize ulcer and assess for bleeding

Treatment:

• H. pylori eradication (if present): Triple or quadruple therapy with antibiotics + PPI

• NSAIDs: Discontinuation; PPI if necessary to continue (high-risk patients)

• PPI or H2 blocker therapy for 4-8 weeks

• Lifestyle modifications: Avoid NSAIDs, alcohol, smoking

4. Biliary Colic (Gallbladder Pain)

Mechanism: Gallstones obstruct the cystic duct or biliary tree, causing spasm and pain

Risk Factors (4 F’s):

• Female: Women 2-3 times more likely

• Forty: Peak incidence in 40s-50s

• Fat: Obesity increases risk

• Fertile: Pregnancy and estrogen increase risk

Symptoms:

• Sudden onset right upper quadrant or epigastric pain

• Severe, colicky (intermittent waves of intensity)

• Often triggered by fatty meal

• Duration: 15 minutes to several hours (then resolves)

• Nausea/vomiting common

• May radiate to right shoulder

When Urgent:

• Fever + pain + jaundice = cholecystitis (infection) or choledocholithiasis (stone in common bile duct)

• Requires urgent imaging and evaluation

5. Acute Pancreatitis

Mechanism: Inflammation of pancreas from activation of digestive enzymes within pancreatic tissue

Causes (80-90% of cases):

• Gallstones: Present in 50% of cases; small stones pass through duct

• Alcohol: Heavy alcohol consumption (accounts for other 40%)

• Less Common: Medications, high triglycerides, abdominal trauma, ERCP (procedure), infections, autoimmune disease, genetic predisposition

Symptoms:

• Acute epigastric pain radiating to back (back pain is key feature)

• Pain often severe and persistent

• Nausea and vomiting (may be profuse)

• May trigger ileus (stomach/intestine stops moving food)

• Elevated abdominal temperature/fever possible

• Tachycardia (rapid heart rate)

Diagnosis:

• Elevated amylase and lipase (pancreatic enzymes)

• Imaging (ultrasound or CT) shows pancreatic inflammation

Severity:

• Mild: Pain, elevated enzymes, self-limited recovery

• Severe: SIRS (systemic inflammatory response), organ dysfunction, necrosis of pancreatic tissue

• Mortality: 1-3% in mild cases; up to 30% in severe cases

Treatment:

• Hospitalization for moderate-severe cases

• NPO (nothing by mouth) initially; IV fluids

• Pain management (narcotics often required)

• Nutritional support (NG feeding or TPN if prolonged)

• Treatment of underlying cause (gallstone removal, alcohol cessation)

Complications:

• Acute respiratory distress syndrome (ARDS)

• Renal failure

• Sepsis

• Pseudocyst formation

• Chronic pancreatitis (if recurrent)

6. Appendicitis

Mechanism: Inflammation or infection of appendix (small tube at junction of small and large intestine)

Symptoms (Classic Presentation):

• Pain begins periumbilically (around belly button)

• Migrates to right lower quadrant (McBurney’s point, 1/3 distance from umbilicus to right anterior superior iliac spine)

• Presents with nausea, vomiting, anorexia

• Low-grade fever

• Loss of appetite

Key Point: Classic appendicitis is right lower quadrant pain, not upper abdominal pain. However, atypical presentations exist (retrocecal appendix high in right upper quadrant).

Diagnosis:

• CT imaging with contrast

• Ultrasound (particularly in children and pregnant women)

• Clinical evaluation (McBurney’s point tenderness, Rebound tenderness)

Treatment:

• Surgical appendectomy (standard treatment)

• Laparoscopic or open approach

Emergency Factors:

• Perforation risk increases over time; mortality increases dramatically with perforation

• Peritonitis from perforation is life-threatening

• Requires emergency surgical evaluation if suspected

7. Bowel Obstruction (Ileus)

Mechanism: Blockage or paralysis preventing normal intestinal movement

Causes:

• Mechanical: Adhesions (from prior surgery), hernia, tumors, strictures, volvulus (twisting)

• Functional (Ileus): Paralysis from surgery, trauma, infection, electrolyte abnormalities, medications

Symptoms:

• Acute abdominal cramping pain

• Inability to pass stool

• Inability to pass gas (particularly concerning sign)

• Abdominal distension (bloating)

• Vomiting (may be bilious or feculent if late obstruction)

• Constipation

Red Flag Symptoms (Require Emergency Care):

• Absence of stool and gas >24 hours (classic red flag for obstruction)

• Severe pain

• Distension with signs of sepsis (fever, tachycardia, hypotension)

• Signs of perforation

Diagnosis:

• CT abdomen/pelvis (gold standard)

• Plain abdominal X-rays (may show air-fluid levels, distension)

• Clinical examination

Treatment:

• Mechanical obstructions: Often require surgical intervention

• Ileus: Supportive care, NPO status, NG tube, IV fluids, address underlying cause

• Conservative management attempted initially; surgery if fails

Chronic/Recurrent Stomach Pain (Weeks to Months to Years)

Characteristics:

• Develops gradually or has recurrent episodes

• Chronic inflammation or functional disorder typically involved

• Different diagnostic and treatment approach than acute pain

Common Chronic Causes:

1. Gastroesophageal Reflux Disease (GERD)

Mechanism: Stomach acid refluxes into esophagus, causing inflammation

Causes:

• Lower esophageal sphincter (LES) dysfunction

• Increased intra-abdominal pressure (obesity, pregnancy, tight clothing)

• Delayed gastric emptying

• Increased gastric acid production

Risk Factors:

• Obesity

• Smoking

• Alcohol

• Large meals

• Acidic foods (citrus, tomato, chocolate, caffeine, spicy foods)

• Medications (NSAIDs, calcium channel blockers, bisphosphonates)

• Pregnancy

Symptoms:

• Heartburn (burning epigastric pain or substernal chest pain)

• Regurgitation of food or liquid

• Chronic cough

• Throat clearing

• Difficulty swallowing (dysphagia)

• Pain typically worse after eating, when lying down, or bending

Diagnosis:

• Clinical presentation often sufficient

• Upper endoscopy if alarm symptoms (dysphagia, weight loss, bleeding)

• 24-hour pH monitoring if diagnosis unclear

Treatment:

• Lifestyle modifications: Weight loss, smoking cessation, alcohol reduction, dietary changes (avoid triggers), elevate head of bed, wait 3 hours after meals before lying down

• Antacids for acute relief (calcium carbonate, magnesium hydroxide)

• H2 blockers: Reduce acid production; taken before meals or bedtime (cimetidine, famotidine, ranitidine)

• PPIs: More potent acid suppression (omeprazole, lansoprazole, esomeprazole); taken daily; most effective but long-term use has risks (B12 deficiency, osteoporosis, C. difficile risk)

• Prokinetic agents: Promote gastric emptying (metoclopramide)

• Surgical intervention: Fundoplication (wrapping stomach around esophagus) for severe, refractory cases or if intolerant of medical therapy

2. Chronic Gastritis

Mechanism: Persistent inflammation of stomach lining

Types:

Type A (Autoimmune):

• Autoimmune destruction of stomach lining

• Results in loss of parietal cells (producing acid and intrinsic factor)

• Leads to achlorhydria (no acid) and B12 deficiency

• Associated with other autoimmune conditions

• Increased risk of gastric cancer

Type B (Bacterial: H. pylori):

• Most common worldwide

• Chronic H. pylori infection causes chronic active gastritis

• May progress to atrophy, intestinal metaplasia, dysplasia, and gastric cancer

• Eradication therapy prevents progression

Type C (Chemical/Reactive):

• From refluxed bile (after surgery) or NSAIDs

• Inflammation without H. pylori

• Results from direct chemical irritation

Symptoms:

• Epigastric pain or discomfort

• Early satiety (feeling full quickly)

• Nausea

• Anorexia (loss of appetite)

• Weight loss (in severe cases)

• Symptoms may be minimal or absent (discovered incidentally on endoscopy)

Diagnosis:

• Endoscopy with biopsy showing chronic inflammation

• H. pylori testing (if suspected)

• Atrophy assessment (serum pepsinogen levels)

Treatment:

• H. pylori eradication (if present)

• PPI therapy to reduce acid and symptoms

• Address underlying causes (stop NSAIDs)

• Monitor for complications (B12 deficiency, cancer)

3. Peptic Ulcer Disease (Chronic Presentation)

Covered in acute section; chronic form involves ongoing symptoms with periods of remission and recurrence.

Characteristics:

• Chronic epigastric pain

• Often episodic with good and bad periods

• May continue for years without treatment

• Risk of complications (bleeding, perforation) remains

Chronic Phase Management:

• H. pylori eradication (if present)

• PPI maintenance therapy

• NSAID avoidance

• Regular follow-up to assess healing and monitor for complications

4. Functional Dyspepsia (Indigestion)

Mechanism: Symptoms of indigestion without identifiable organic pathology

Subtypes:

• Postprandial Distress Syndrome: Early satiety, bloating, nausea after meals

• Epigastric Pain Syndrome: Epigastric burning or pain, not meal-related

Causes (Proposed Mechanisms):

• Impaired gastric accommodation (stomach doesn’t relax adequately when food enters)

• Delayed gastric emptying

• Visceral hypersensitivity (stomach lining overly sensitive to normal stimuli)

• Helicobacter pylori infection (in some cases)

• Psychosocial factors (stress, anxiety)

Prevalence: Affects 20% of population; very common

Symptoms:

• Epigastric pain or discomfort

• Early satiety

• Bloating and gas

• Nausea

• Symptoms triggered by eating

• No identifiable organic disease on testing

Diagnosis:

• Upper endoscopy (normal; must rule out ulcers, cancer, severe GERD)

• Testing for H. pylori

• Rule out other conditions with appropriate evaluation

Treatment:

• Dietary modification: Smaller, frequent meals; avoid fatty, spicy, acidic foods

• Stress reduction

• Pharmacological:

  • PPI or H2 blocker trial (may help some patients)

  • Prokinetics (metoclopramide, domperidone): Promote gastric emptying

  • Tricyclic antidepressants: Low-dose (amitriptyline) for visceral pain

  • Psychological therapy: Cognitive behavioral therapy effective in some cases

• Many cases improve with reassurance that no serious pathology present

5. Irritable Bowel Syndrome (IBS)

Mechanism: Functional disorder of small and large intestine; abnormal motility and visceral sensitivity

Subtypes:

• IBS-D: Diarrhea-predominant

• IBS-C: Constipation-predominant

• IBS-M: Mixed pattern

• IBS-U: Unspecified

Risk Factors:

• Psychological stress and anxiety

• Female gender (2:1 female to male ratio)

• History of intestinal infection (post-infectious IBS)

• Food sensitivities or intolerances

• Altered gut microbiota

Symptoms:

• Recurrent abdominal pain/cramping

• Altered bowel habits (diarrhea, constipation, or both)

• Bloating and abdominal distension

• Mucus in stools

• Symptoms triggered by stress or eating

• May involve upper abdomen (epigastric) or lower (umbilical)

Diagnosis:

• Rome IV Criteria: Pain at least 1 day/week for 3 months, combined with altered bowel habits

• Rule out organic disease (endoscopy, colonoscopy if appropriate)

• No specific test confirms IBS

Treatment:

• Dietary: Low-FODMAP diet (restricts fermentable carbohydrates) effective in many cases

• Behavioral: Stress reduction, regular exercise, sleep optimization

• Pharmacological:

  • Antidiarrheals (loperamide) for diarrhea

  • Laxatives or osmotic agents for constipation

  • Antispasmodics (dicyclomine, hyoscyamine): Reduce cramping

  • SSRIs or tricyclic antidepressants: Effective for pain and mood

  • IBS-specific agents: Linaclotide (increases intestinal motility and secretions)

• Psychological therapy: Cognitive behavioral therapy, hypnotherapy effective in many cases

• Probiotics: Mixed evidence; may help some patients

6. Inflammatory Bowel Disease (IBD)

Types:

• Crohn’s Disease: Chronic inflammation of any part of GI tract (mouth to anus); transmural (full thickness)

• Ulcerative Colitis: Chronic inflammation limited to colon and rectum; mucosal (superficial)

Both are chronic inflammatory conditions with periods of remission and exacerbation.

Symptoms (Can Vary Significantly):

• Abdominal pain and cramping

• Diarrhea (often bloody in UC)

• Weight loss

• Fever

• Malaise

• Extraintestinal manifestations (joint pain, skin lesions, eye inflammation, liver disease)

Note: IBD typically presents with lower abdominal or generalized pain, though upper abdominal involvement possible in Crohn’s.

Diagnosis:

• Colonoscopy with biopsy

• Imaging (CT enterography for Crohn’s, colonoscopy for UC)

• Laboratory markers: Elevated inflammatory markers (ESR, CRP)

Treatment:

• Immunosuppressive medications (mesalamine, corticosteroids, azathioprine, biologics like TNF inhibitors)

• Dietary management

• Surgical intervention for severe disease or complications

7. Celiac Disease

Mechanism: Autoimmune response to gluten (protein in wheat, barley, rye) causing intestinal inflammation

Symptoms:

• Abdominal pain and cramping

• Chronic diarrhea or constipation

• Bloating and gas

• Weight loss

• Malabsorption manifestations (anemia, bone loss, vitamin deficiencies)

• Fatigue

• Dermatitis herpetiformis (itchy skin rash)

Diagnosis:

• Serologic testing: Tissue transglutaminase (tTG) IgA antibodies

• Endoscopy with small bowel biopsy (shows villous atrophy)

• Genetic testing for HLA-DQ2 or HLA-DQ8

Treatment:

• Strict gluten-free diet (lifelong)

• Nutritional supplementation for deficiencies

8. Lactose Intolerance

Mechanism: Deficiency of lactase enzyme; inability to digest lactose (milk sugar)

Symptoms:

• Epigastric or generalized abdominal pain/cramping

• Bloating and gas

• Diarrhea

• Nausea

• Onset 30 minutes to 2 hours after dairy consumption

Diagnosis:

• Hydrogen breath test (unabsorbed lactose produces hydrogen detected in breath)

• Clinical history

Treatment:

• Dietary avoidance of lactose-containing foods

• Lactase enzyme supplements

• Dairy alternatives

• Gradual introduction of lactose (many people develop tolerance)

9. Chronic Pancreatitis

Mechanism: Long-standing inflammation and fibrosis of pancreas, causing permanent damage

Causes:

• Chronic alcohol abuse (most common)

• Recurrent acute pancreatitis

• Genetic predisposition

• Autoimmune

• Ductal obstruction

Symptoms:

• Chronic epigastric and back pain

• Pain triggered by eating (especially fatty foods)

• Weight loss

• Steatorrhea (fatty stools)

• Diabetes (from pancreatic beta cell destruction)

• Malabsorption

• Symptoms progressive and often debilitating

Diagnosis:

• Imaging (CT, MRI, endoscopic ultrasound) shows pancreatic atrophy and fibrosis

• Elevated amylase/lipase (often normal despite symptoms)

• Fecal fat test for malabsorption

Treatment:

• Pain management (often challenging)

• Pancreatic enzyme replacement

• Fat-soluble vitamin supplementation (ABDE)

• Diabetes management

• Alcohol cessation

• Surgical intervention for severe pain or complications (sphincteroplasty, drainage procedures)

10. Stomach Cancer (Gastric Adenocarcinoma)

Mechanism: Malignant tumor of stomach lining

Risk Factors:

• H. pylori infection (strong association)

• Smoking

• Heavy alcohol

• Genetic predisposition (hereditary diffuse gastric cancer)

• Intestinal metaplasia from chronic atrophic gastritis

• Family history

• Lower SES, poor sanitation

Symptoms (Often Late Presentation):

• Epigastric pain or discomfort

• Early satiety

• Weight loss (progressive)

• Anorexia

• Nausea/vomiting (may be bloody)

• Dysphagia (if involves gastroesophageal junction)

• Fatigue

• Symptoms often absent in early stages

Diagnosis:

• Upper endoscopy with biopsy (definitive)

• Imaging for staging (CT, PET)

Prognosis:

• Stage-dependent; overall poor if diagnosed late

• 5-year survival: ~31% in U.S. (much lower than many cancers)

• Early detection dramatically improves outcomes

Prevention:

• H. pylori eradication in high-risk populations

• Smoking cessation

• Dietary modifications (reduce salt, processed meats; increase vegetables)

11. Hiatus Hernia

Mechanism: Portion of stomach protrudes through esophageal hiatus of diaphragm into thoracic cavity

Types:

• Sliding Hernia: Cardia (junction of esophagus and stomach) and fundus slide into thorax; most common (90%)

• Paraesophageal: Fundus herniates alongside esophagus; can cause acute obstruction

Risk Factors:

• Increased intra-abdominal pressure

• Weakened lower esophageal sphincter

• Chronic cough

• Obesity

• Pregnancy

• Age (more common with aging)

Symptoms:

• Often asymptomatic

• When symptomatic: GERD symptoms (heartburn, regurgitation)

• Epigastric pain

• Dysphagia

• Chest pain (may mimic cardiac pain)

• Belching, bloating

Diagnosis:

• Upper endoscopy

• Barium X-ray

• Manometry if LES function in question

Treatment:

• Symptomatic: Same as GERD (lifestyle modifications, PPIs)

• Surgical: Fundoplication for severe symptoms, complicated hernias, or if surgery needed for other reasons

12. Acute Coronary Syndrome (ACS) – Important Mimicker

Critical Point: Not all epigastric pain is GI origin. Cardiac pathology must be excluded.

Mechanism: Blocked coronary artery causing myocardial ischemia/infarction

Atypical Presentations (Especially in Women, Elderly, Diabetics):

• Epigastric pain or “indigestion”

• Shortness of breath

• Nausea/vomiting

• May lack classic chest pain

Red Flags:

• Risk factors present (age, smoking, hypertension, diabetes, high cholesterol, family history)

• Pain associated with exertion

• Pain radiates to arm, jaw, or back

• Diaphoresis (sweating)

• Dyspnea

Diagnosis:

• ECG (must be done for any concerning epigastric pain in appropriate population)

• Troponin (cardiac enzyme)

Treatment: Requires emergency evaluation and treatment

Digestive Parasites

Overview: Less common in developed countries; important in tropical regions and immunocompromised individuals

Common Parasites:

• Giardia lamblia: Causes diarrhea, malabsorption, abdominal pain

• Entamoeba histolytica: Can cause dysentery and severe infection

• Ascaris lumbricoides: Can cause obstruction if heavy load

• Hookworms: Cause anemia and protein malabsorption

Symptoms:

• Chronic diarrhea

• Abdominal pain and cramping

• Weight loss

• Malabsorption

• Bloating and gas

Diagnosis:

• Stool ova and parasites (may require multiple samples)

• Serology for specific parasites

• Endoscopy with biopsy (for some parasites)

Treatment:

• Antiparasitic medications (specific to organism)

• Treatment often curative if organism eliminated

Red Flag Symptoms Requiring Emergency Evaluation

Certain symptoms require immediate medical evaluation, often emergency care:

Symptoms Requiring Emergency Department Visit:

1. Severe Acute Abdominal Pain

   • Sudden onset severe pain

   • Associated with peritonitis signs (rigid abdomen, rebound tenderness, guarding)

   • Risk of serious pathology (perforation, obstruction, bleeding)

2. Hematemesis (Vomiting Blood)

   • Indicates GI bleeding

   • Risk of hemorrhagic shock

   • Requires emergency endoscopy

   • Possible causes: Ulcer perforation, esophageal varices, severe gastritis, Mallory-Weiss tear

3. Melena or Hematochezia (Blood in Stool)

   • Indicates GI bleeding

   • Risk of anemia, shock

   • Melena (black tarry stool) suggests upper GI bleeding

   • Hematochezia (bright red blood per rectum) suggests lower GI or brisk upper GI bleeding

   • Requires evaluation and possible transfusion

4. Signs of Perforation

   • Sudden severe epigastric pain

   • Rigid, board-like abdomen (peritonitis)

   • Hypotension, tachycardia (shock)

   • Risk of sepsis, death

   • Requires emergency surgery

5. Absence of Stool/Gas >24 Hours + Severe Pain

   • Indicates possible obstruction

   • Concern for bowel necrosis if prolonged

   • Risk of perforation and sepsis

   • Requires urgent imaging and evaluation

6. Severe Pancreatitis Features

   • Epigastric pain radiating to back

   • Severe pain unresponsive to analgesics

   • Signs of sepsis (fever, tachycardia, hypotension)

   • Elevated pancreatic enzymes

   • Risk of organ failure

7. Fever + Right Upper Quadrant Pain

   • Suggests cholecystitis or cholangitis

   • Risk of sepsis

   • Requires urgent imaging and antibiotics

8. Severe Pain + Jaundice

   • Suggests biliary obstruction (stone, cancer)

   • Requires urgent evaluation

9. Signs of Shock

   • Hypotension (systolic <90)

   • Tachycardia (>110)

   • Altered mental status

   • Severe pain

   • Indicates life-threatening pathology

   • Requires emergency care

When to Consult Your Healthcare Provider: Non-Emergency Referral Indications

Schedule an Appointment If You Experience:

• Persistent mild-moderate pain: Lasting >1-2 weeks despite home care

• Recurrent pain: Episodes recurring weekly or more frequently

• Pain with alarm symptoms:

  • Difficulty swallowing

  • Persistent vomiting

  • Weight loss (unexplained)

  • Loss of appetite

  • Anemia symptoms (fatigue, pallor, dyspnea)

  • Dark stools or signs of bleeding

• Nighttime awakening: Pain severe enough to wake from sleep

• Pain affecting function: Interfering with eating, work, or daily activities

• Medication intolerance: Side effects preventing medication use

• New pain pattern: Change in character, timing, or severity of chronic pain

• Concerns about cancer: Family history or prolonged symptoms

Expected Timeline for Appointment:

• Acute concerning symptoms: Same-day or next-day appointment; may need urgent care if physician unavailable

• Recurrent symptoms: Within 1-2 weeks

• Chronic stable symptoms: Within 2-4 weeks; may be scheduled in routine clinic

Diagnostic Evaluation of Stomach Pain

How Physicians Diagnose the Cause

The diagnostic process is systematic and builds from information gathering to targeted testing.

Step 1: Detailed History Taking

The physician will ask about:

Onset and Duration:

• When did pain start? (Sudden vs. gradual)

• How long does each episode last? (Minutes, hours, days)

• Is it continuous or intermittent?

• Is it getting worse or improving?

Pain Characteristics:

• Where exactly is the pain? (Epigastric, right upper quadrant, left upper quadrant, periumbilical, lower abdomen)

• What does it feel like? (Burning, cramping, aching, sharp, dull, pressure)

• On a scale of 1-10, how severe is it?

• Does it radiate? (To back, shoulder, chest)

Relationship to Food and Meals:

• Does eating trigger pain or worsen it?

• Does eating relieve pain?

• How long after eating does pain occur?

• Are certain foods problematic? (Fatty, spicy, acidic)

• Does pain occur when stomach is empty?

Associated Symptoms:

• Nausea or vomiting? (Timing, frequency, content—blood, food, bile)

• Diarrhea or constipation?

• Bloating or gas?

• Change in appetite?

• Weight loss? (How much, over what time)

• Fever?

• Fatigue or weakness?

• Changes in stool color or consistency?

• Jaundice (yellowing of skin/eyes)?

Exacerbating and Relieving Factors:

• What makes pain worse?

• What makes pain better?

• Does antacid help?

• Does rest help?

• Does specific position help?

Past Medical History:

• Prior similar episodes?

• History of ulcers, GERD, IBS?

• Autoimmune conditions?

• Diabetes or other metabolic disease?

• Cancer in family?

Medications:

• Currently taking NSAIDs?

• Medications that might cause symptoms?

• Recent antibiotic use (C. difficile concern)?

Lifestyle:

• Tobacco use?

• Alcohol use (quantity, frequency)?

• Stress level?

• Recent travel (parasites)?

• Recent illness (possible gastroenteritis)?

Step 2: Physical Examination

The physician will perform:

Vital Signs:

• Temperature (fever suggests infection or inflammation)

• Blood pressure (hypotension suggests shock)

• Heart rate (tachycardia with pain or suggests shock)

• Respiratory rate (rapid breathing with pain or shock)

Abdominal Examination:

• Inspection: Distension (bloating), visible peristaltic waves, scars from prior surgery

• Auscultation (Listening): Bowel sounds (normal, hyperactive suggesting diarrhea, absent suggesting ileus or peritonitis)

• Palpation (Touching):

  • Gentle palpation to identify areas of tenderness

  • Checking for guarding (involuntary muscle tension from peritoneal irritation)

  • Rebound tenderness (pain when hand is suddenly released; suggests peritonitis)

  • Costovertebral angle (CVA) tenderness (kidney pain)

  • Specific maneuvers: Murphy’s sign (right upper quadrant pain with breath; suggests cholecystitis), McBurney’s point (appendicitis), Rovsing’s sign (appendicitis)

  • Liver, spleen, kidney assessment

• Percussion: Detects fluid, gas, or solid structures

Other:

• Lymph node examination

• Skin examination (jaundice, rashes)

• Rectal examination (if indicated)

Step 3: Initial Laboratory Studies

Basic Laboratory Tests:

• Complete Blood Count (CBC):

  • Elevated WBC: Suggests infection or inflammation

  • Anemia: Suggests chronic bleeding or malabsorption

• Comprehensive Metabolic Panel (CMP):

  • Liver function tests (AST, ALT, bilirubin): Elevated in liver/biliary disease

  • Electrolytes: Derangement suggests dehydration or severity of illness

  • Renal function: Important if considering certain medications or contrast

• Amylase and Lipase: Elevated in pancreatitis

• Fecal Occult Blood Test (FOBT): Detects blood in stool

• H. pylori Testing (If suspecting ulcer):

  • Urea breath test

  • Stool antigen

  • Serum antibodies

  • Endoscopic biopsy (most accurate)

• Celiac Serology (If suspecting celiac):

  • Tissue transglutaminase (tTG) IgA

  • Endomysial antibodies (EMA)

Step 4: Imaging Studies

Ultrasound:

• First-line for gallbladder evaluation

• Can assess for free fluid, masses

• Operator and body habitus dependent

• No radiation

CT Abdomen/Pelvis with Contrast:

• Gold standard for many abdominal pathologies

• Excellent for evaluating: Pancreatitis, obstruction, appendicitis, diverticulitis, perforation

• Can assess for masses, inflammation

• Exposes patient to radiation

MRI/MRCP (Magnetic Resonance Imaging/Cholangiopancreatography):

• Excellent for biliary tree and pancreatic duct evaluation

• No radiation

• Useful for suspected stones in common bile duct

• More expensive and time-consuming

Plain Abdominal X-rays:

• Limited utility

• Useful for assessing gas pattern (obstruction, ileus)

• Can show free air (perforation)

• Less sensitive than CT

Step 5: Endoscopic Evaluation

Upper Endoscopy (EGD – Esophagogastroduodenoscopy):

• Direct visualization of esophagus, stomach, duodenum

• Allows biopsies, treatment (hemostasis for bleeding)

• Gold standard for diagnosing/treating ulcers, gastritis, esophagitis, GERD complications

• Can detect H. pylori, malignancy

• Indications: Alarm symptoms, documented bleeding, refractory GERD, suspected malignancy

Colonoscopy:

• Direct visualization of colon and rectum

• Allows biopsy, polyp removal

• Indicated for: Persistent diarrhea, bloody stools, age-appropriate screening, IBD evaluation

Capsule Endoscopy:

• Swallowed camera visualizes small intestine

• Used for obscure GI bleeding, Crohn’s disease evaluation

• Less invasive than push enteroscopy

Step 6: Specialized Testing

Esophageal Manometry:

• Measures esophageal contractions

• Evaluates LES function

• Indicated for: Refractory GERD, dysphagia, possible achalasia

Hydrogen Breath Test:

• Tests for lactose intolerance, small intestinal bacterial overgrowth (SIBO)

• Patient drinks lactose or other sugar, hydrogen measured in breath

Gastric Emptying Study:

• Assesses how quickly stomach empties

• Indicated for: Suspected delayed gastric emptying, refractory symptoms

Stool Studies:

• Ova and parasites (parasitic infections)

• Culture (bacterial infection)

• C. difficile toxin (if recent antibiotics and diarrhea)

• Fat content (malabsorption)

Typical Diagnostic Pathways by Suspected Diagnosis

Suspected GERD/Peptic Ulcer Disease:

1. History and physical exam

2. H. pylori testing (breath, stool, or endoscopy)

3. PPI trial (therapeutic/diagnostic)

4. Upper endoscopy if: Alarm symptoms, age >60, chronic symptoms, failed treatment

Suspected Cholecystitis/Choledocholithiasis:

1. History and physical exam

2. Liver function tests

3. Ultrasound abdomen (first-line imaging)

4. MRCP if stone in common bile duct suspected

5. CT if urgent imaging needed (cholecystitis with complications)

Suspected Pancreatitis:

1. History and physical exam

2. Amylase and lipase

3. Liver function tests (evaluate for biliary cause)

4. CT abdomen/pelvis

5. MRCP if stone or ductal involvement suspected

Suspected IBS:

1. History meeting Rome IV criteria

2. CBC and CMP (rule out organic disease)

3. Celiac serology (rule out celiac)

4. Fecal calprotectin (rule out IBD) if indicated

5. Limited imaging if alarm symptoms present

Suspected Appendicitis:

1. History and physical examination

2. CT abdomen/pelvis with IV contrast (95%+ sensitivity)

3. Ultrasound in children/pregnant women

4. Clinical assessment; imaging supports diagnosis

Suspected Obstruction:

1. History and physical exam

2. Abdominal X-rays (initial)

3. CT abdomen/pelvis if unclear or complications suspected

4. Serial exams if conservatively managing

Treatment Approaches: From Medications to Natural Remedies

Conventional Medical Treatments

Antacids

Mechanism: Neutralize stomach acid, increasing pH

Common Types:

• Calcium Carbonate (Tums, Rolaids): Fast-acting; contains calcium; constipating

• Magnesium Hydroxide (Milk of Magnesia): Laxative effect

• Aluminum Hydroxide: Constipating

• Sodium Bicarbonate (Baking Soda): Systemic alkalinization; can cause metabolic alkalosis if overused

Use:

• For acute heartburn

• Between meals or at bedtime

• Not for chronic management (better options available)

Limitations:

• Short duration (30 minutes to 3 hours)

• Don’t heal ulcers

• Some side effects (aluminum toxicity in kidney disease, magnesium diarrhea)

H2 Receptor Blockers

Mechanism: Reduce stomach acid production by blocking histamine-2 receptors

Common Agents:

• Famotidine (Pepcid)

• Cimetidine (Tagamet)

• Ranitidine (Zantac) – largely withdrawn due to NDMA contamination

Dosing:

• Short-term: 4-6 weeks for acute ulcers

• Maintenance: Once or twice daily for chronic conditions

Efficacy:

• Modest acid reduction (60-80%)

• Effective for mild-moderate GERD, peptic ulcers

• Less effective than PPIs

Side Effects:

• Generally well-tolerated

• Cimetidine: CYP450 inhibitor; drug interactions

• Famotidine: Better side effect profile

Proton Pump Inhibitors (PPIs)

Mechanism: Block final step of gastric acid production; most potent acid suppressants

Common Agents:

• Omeprazole (Prilosec)

• Lansoprazole (Prevacid)

• Esomeprazole (Nexium)

• Pantoprazole (Protonix)

• Rabeprazole (Aciphex)

Dosing:

• Typically once daily, before breakfast

• Higher doses or twice daily for severe disease

Efficacy:

• 90%+ acid suppression

• Highly effective for GERD, ulcers, gastritis

• Heals ulcers in 4-8 weeks

Use Duration:

• Short-term (4-8 weeks) for acute conditions

• Long-term for chronic GERD, Barrett’s esophagus, chronic pancreatitis

• Concerns about very long-term use

Side Effects and Concerns:

• B12 Deficiency: Chronic use impairs B12 absorption; monitor levels in long-term users

• Bone Loss: Associated with osteoporosis in long-term use; consider calcium/vitamin D supplementation

• Magnesium Depletion: Can cause hypomagnesemia; monitor if chronic use

• Hyponatremia: Rare; more common in elderly

• C. difficile Risk: Altered gut flora; increased infection risk

• Drug Interactions: CYP3A4/2C19 inhibition; affects metabolism of other drugs

• Renal Disease: Possible association with chronic kidney disease (causation uncertain)

• Fractures: Increased fracture risk in long-term users, especially at hip

• Other: Headache, constipation, diarrhea, rash (rare)

Recommendations:

• Use lowest effective dose

• Use for shortest duration possible

• Address underlying condition to allow discontinuation

• Monitor B12, magnesium, calcium in chronic users

• Supplement calcium and vitamin D in long-term users

Prokinetic Agents

Mechanism: Enhance gastric contractions and gastric emptying

Common Agents:

• Metoclopramide (Reglan): Dopamine antagonist; crosses blood-brain barrier

• Domperidone (Motilium): Dopamine antagonist; doesn’t cross blood-brain barrier (not available in U.S.)

Dosing:

• Metoclopramide: 10mg three times daily before meals

Efficacy:

• Modestly improves gastric emptying

• May help functional dyspepsia and GERD

• Mixed evidence for efficacy

Side Effects (Particularly Metoclopramide):

• Tardive Dyskinesia: Involuntary movements; risk increases with dose and duration; concerning with long-term use (>3 months)

• Acute Dystonia: Muscle spasms (can be reversed with diphenhydramine)

• Neuroleptic Malignant Syndrome: Rare; severe

• Restlessness, anxiety, tremor

• Galactorrhea: Breast milk production

• Amenorrhea: Absence of menstrual periods

FDA Black Box Warning: Metoclopramide carries FDA black box warning for tardive dyskinesia with long-term use; typically limited to 3-4 weeks

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Antispasmodic Agents

Mechanism: Reduce smooth muscle contractions in GI tract; anticholinergic effects

Common Agents:

• Dicyclomine (Bentyl)

• Hyoscyamine (Levsin)

• Cimetropium Bromide

Use:

• Functional dyspepsia

• IBS-related cramping

• Gastroenteritis cramping

Dosing: Varies by agent; typically 3-4 times daily before meals

Efficacy:

• Modest benefit for cramping

• Evidence limited for IBS

Side Effects (Anticholinergic):

• Dry mouth

• Constipation

• Blurred vision

• Urinary retention

• Tachycardia

• Avoid in glaucoma or urinary obstruction

Antibiotics (For Infection-Related Causes)

H. pylori Eradication (Triple or Quadruple Therapy):

• Most common: PPI + Amoxicillin + Clarithromycin (7-14 days)

• Alternative: PPI + Bismuth + Metronidazole + Tetracycline (14 days) if resistant

• Success rate: 85-90% with standard therapy

C. difficile Infection:

• Fidaxomicin preferred (toxin-binding agent; low recurrence)

• Vancomycin oral if severe

• Metronidazole if mild disease

Other Infections:

• Specific organisms identified on culture

• Antibiotic selected based on susceptibility

Surgical Interventions

Indicated For:

• Perforated peptic ulcer (emergency repair)

• Gastric outlet obstruction from ulcer or scarring

• Severe refractory GERD (fundoplication)

• Appendicitis (appendectomy)

• Bowel obstruction (lysis of adhesions, resection of obstructed segment)

• Gallstones with complications (cholecystectomy)

• Severe pancreatitis with necrosis or complications

• Gastric cancer (gastrectomy)

Natural and Complementary Remedies

While natural remedies should not replace evidence-based medical treatment for serious conditions, some have modest evidence for symptomatic relief of mild gastrointestinal discomfort.

Dietary Approaches

Foods Supporting Digestion:

• Ginger: Anti-inflammatory; may reduce nausea and inflammation

  • Use: Fresh ginger tea (slice fresh ginger, steep in hot water), or culinary amounts

• Turmeric: Curcumin has anti-inflammatory properties

  • Use: Golden milk, curry spice

• Fennel Seeds: Traditional remedy; anti-gas properties

  • Use: Chew seeds or steep in water as tea

• Licorice (DGL – Deglycyrrhizinated): May protect stomach lining

  • Use: Supplement form; avoid whole licorice (can increase blood pressure)

• Aloe Vera: May have soothing properties (avoid latex)

  • Use: Juice or gel; ensure latex-free preparation

• Bone Broth: Collagen and amino acids may support gut lining

  • Use: Regular consumption

• Fermented Foods: Support healthy gut bacteria

  • Use: Sauerkraut, kimchi, kefir, miso (if tolerated)

• Probiotics: May support beneficial gut bacteria

  • Use: Yogurt with active cultures, supplements

  • Note: Evidence mixed; strains and quality vary

Foods to Avoid in Sensitive Individuals:

• Spicy foods (capsaicin irritates stomach lining)

• Acidic foods (citrus, tomato, vinegar)

• Fatty/greasy foods (slow gastric emptying)

• Caffeine and chocolate (relax lower esophageal sphincter)

• Alcohol (irritates stomach lining)

• Carbonated beverages (increase gas/bloating)

• Large meals (overwhelm stomach)

Herbal Remedies

Peppermint: May help functional dyspepsia and IBS

• Use: Tea or supplement

• Caution: May worsen GERD

Chamomile: Anti-inflammatory; relaxing

• Use: Tea

• Safety: Generally safe

Thyme: Anti-inflammatory; traditional use

• Use: Tea or culinary

• Safety: Generally safe

Basil: Anti-inflammatory; traditional use

• Use: Culinary or tea

• Safety: Generally safe

Dill: Anti-gas properties

• Use: Culinary or tea

• Safety: Generally safe

Slippery Elm: May coat stomach lining

• Use: Tea or supplement

• Safety: Generally safe

Marshmallow Root: May soothe stomach lining

• Use: Tea or supplement

• Safety: Generally safe

Echinacea: Immune support; may help with infection-related gastritis

• Use: Supplement

• Evidence: Mixed

Ginseng: Anti-inflammatory; traditional use

• Use: Supplement or culinary

• Caution: May interact with medications

Other Natural Approaches

Stress Reduction:

• Meditation, mindfulness, yoga

• Regular exercise

• Adequate sleep

• Deep breathing techniques

• Psychology: Cognitive behavioral therapy effective for functional disorders

Dietary Modifications:

• Eat smaller, more frequent meals

• Chew food thoroughly

• Eat slowly

• Avoid eating within 3 hours of bedtime

• Limit trigger foods

Lifestyle Changes:

• Maintain healthy weight

• Avoid smoking

• Limit alcohol

• Manage stress

• Regular physical activity

Acupuncture:

• Traditional Chinese medicine

• Evidence: Mixed for GI disorders; some studies suggest benefit for nausea

• May help with symptom relief as adjunct

Massage and Manual Therapy:

• May reduce stress and promote relaxation

• Limited evidence for direct GI benefit

• May help associated tension

Cabbage Juice and Other Traditional Remedies

Cabbage Juice:

• Traditional remedy for ulcers

• Rationale: Contains glutamine (amino acid) and various antioxidants

• Evidence: Limited; some older studies suggested benefit; modern evidence lacking

• Safety: Safe if fresh and prepared properly

• Use: Fresh juice (not commercially preserved); consumed in small amounts

Honey:

• Traditional antimicrobial and soothing agent

• Evidence: Some antimicrobial activity; limited evidence for GI benefit

• Safety: Generally safe; avoid in infants <1 year

• Use: Raw or Manuka honey may have greatest benefit

Bone Broth:

• Contains collagen, amino acids, minerals

• Evidence: Anecdotal; limited research

• Safety: Generally safe if prepared cleanly

• Use: Regular consumption as food

Important Caveat: Natural remedies are not substitutes for evidence-based medical treatment. While they may provide symptomatic relief, underlying conditions (ulcers, infections, cancer) require professional diagnosis and treatment.

Prevention: Reducing Your Risk of Stomach Pain

Preventing Gastritis and Ulcers

NSAID-Related:

• Use lowest effective dose for shortest duration

• Use with food or PPI protection if chronic use necessary

• Consider alternatives (acetaminophen, topical NSAIDs)

• Use selective COX-2 inhibitors if high GI risk

• Monitor for symptoms

H. pylori-Related:

• Practice good hand hygiene

• Avoid contaminated water (especially in endemic areas)

• H. pylori eradication if infected

Alcohol-Related:

• Limit alcohol consumption

• Avoid binge drinking

• Eat with alcohol consumption

Stress-Related:

• Stress management techniques

• Adequate sleep

• Regular exercise

• Mental health support if needed

Preventing GERD

• Maintain healthy weight

• Avoid trigger foods (acidic, fatty, spicy, caffeine, chocolate, alcohol)

• Eat smaller, more frequent meals

• Wait 3+ hours after eating before lying down

• Elevate head of bed 30 degrees

• Avoid tight clothing

• Smoking cessation

• Limit caffeine and alcohol

• Manage stress

Preventing Gallstone-Related Pain

• Maintain healthy weight (avoid rapid weight loss)

• Eat balanced diet with healthy fats

• Stay hydrated

• Regular physical activity

• Limit high-cholesterol foods

• Control risk factors (diabetes, high cholesterol)

Preventing Pancreatitis

• Limit alcohol (single strongest modifiable risk factor)

• If history of gallstones, consider removal

• Control triglyceride levels

• Avoid smoking

• Management of underlying conditions (diabetes, hyperparathyroidism)

Preventing Functional Disorders (IBS, Functional Dyspepsia)

• Stress management (most important)

• Adequate sleep

• Regular exercise

• Dietary management (low-FODMAP diet if IBS)

• Avoid trigger foods

• Psychological support (therapy, CBT)

• Probiotics (evidence mixed; may help some)

General Prevention Strategies

Excellent Hygiene:

• Hand washing before eating and after bathroom

• Proper food handling to avoid contamination

• Clean water source

Dietary Habits:

• Balanced diet with adequate fiber (supports healthy gut bacteria)

• Regular meal times

• Adequate hydration

• Limit highly processed foods

• Adequate nutrient intake

Lifestyle:

• Regular physical activity (30 minutes, most days)

• Adequate sleep (7-9 hours)

• Stress management

• Smoking cessation

• Alcohol moderation

• Healthy weight

Regular Medical Care:

• Regular checkups

• H. pylori screening if appropriate

• Cancer screening per guidelines

• Management of chronic conditions (diabetes)

• Review of medications for GI side effects

Understanding Your Pain: Self-Assessment Guide

Quick Reference: Characteristics Suggesting Different Causes

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When in Doubt: Seeking Professional Evaluation

Remember:

• You are the expert on your own body

• If something feels wrong or is affecting your quality of life, professional evaluation is warranted

• Early diagnosis and treatment prevent complications

• Many serious conditions are highly treatable when caught early

• Diagnostic evaluation is relatively quick and non-invasive in most cases

• Better to have one unnecessary doctor visit than miss something important