Causes of Stomach Pain and Treatment Options

Stomach pain is not all that uncommon. In most cases, it is clearly related to something you either ate (such as with food poisoning), caught (like the stomach flu), or experience routinely (such as gastritis). At other times, it can seem as though it appears out of the blue or after taking medication. If this happens and the symptoms are either severe, persistent, or worsening, you need to see a healthcare provider to investigate the cause.

Several different adjectives may be used to describe stomach pain—burning, stabbing, aching, and so on—and the discomfort is sometimes associated with other symptoms like nausea, vomiting, and excessive gas. This information can be helpful to your healthcare provider when they're working to make a diagnosis.

Causes

The stomach, of course, is its own unique organ. But when people use the term "stomach pain," many mean pain related to the gastrointestinal tract. As such, we also do so here.

Typically speaking, perceived stomach pain that occurs in the part of the abdomen nearer to the ribs involves the upper gastrointestinal (GI) tract, which includes the esophagus, stomach, and small intestines. Pain occurring in the lower abdomen tends to be related to the lower GI tract, which is comprised of the large intestine (colon), rectum, and anus.

It is likely overwhelming to see such a long list of potential causes, but each of these is worth knowing about—especially if you haven't yet been able to get to the bottom of your stomach pain.

Upper Gastrointestinal Tract

Besides your run-of-the-mill stomach bug or the occasional bout of indigestion, here are some health conditions that cause more persistent stomach pain in the upper gastrointestinal tract.

The first three affect the stomach specifically.

Peptic Ulcer

Peptic ulcer is a term used to describe an open sore in the stomach or duodenum. The symptoms can vary, but often include gnawing or burning pain, indigestion, nausea, vomiting, and excessive gas.

Most peptic ulcers are caused by either the bacterium Helicobacter pylori or the use of nonsteroidal anti-inflammatory drugs, which may irritate and alter the protective mucosal layer of the digestive tract.

Gastritis

Gastritis is the medical term for the inflammation in the lining of the stomach. Gastritis is a far-ranging condition caused by everything from alcohol to aspirin and nonsteroidal anti-inflammatory drug (NSAID) use to infection with H. pylori. In some cases, the condition will be idiopathic (meaning no cause is ever found).

Besides pain in the upper belly, which can range from a dull ache to an intensely sharp or burning pain, other symptoms of gastritis include feeling bloated, early satiety, decreased appetite, nausea, and vomiting.

Gastroparesis

Gastroparesis is a condition in which the stomach is slow to empty its contents into the small intestine. This condition is common in people with diabetes, but may also occur idiopathically (without an identified cause).

Besides diffuse aching or cramping abdominal pain, other symptoms of gastroparesis include nausea, a feeling of fullness, and vomiting after eating. In severe cases, a person may lose weight.

Esophagitis

Your esophagus is the tube that carries food from your mouth to your stomach. Esophagitis refers to irritation and inflammation of the lining of the esophagus, which may occur for many reasons, including:

• Infection (for example, Candida or the herpes simplex virus)
• Taking certain medications (for example, the antibiotic clindamycin or aspirin)
• An allergy (called eosinophilic esophagitis)

Besides heartburn and upper-belly pain, a person with esophagitis may notice difficulty swallowing or pain with swallowing.

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD), also known as acid reflux, is a condition in which stomach acid leaks back into the esophagus, causing a burning sensation in the chest or throat.

Besides heartburn, some other symptoms of GERD include regurgitation, trouble swallowing, stomach pain, hoarseness, cough, or feeling like there is a lump in the throat.

Gallstones

Gallstones are caused by the crystallization of bile in the gallbladder. This may lead to the formation of small, jagged stones that block the bile duct and cause severe, sharp pain in the upper-right abdomen (a condition called acute cholecystitis).

There are numerous complications of gallstones, like pancreatitis or acute cholangitis, that may worsen your pain or cause other symptoms.

Pancreatitis

Pancreatitis refers to inflammation of the pancreas, a small gland that releases insulin to regulate your blood sugar levels and also aids in the digestion of fat. Alcohol and gallstone disease are the two most common causes of pancreatitis. Most people with acute pancreatitis develop severe, constant pain in the upper belly.

Celiac Disease

Celiac disease is an autoimmune disorder in which the consumption of gluten causes the immune system to attack the small intestine. In addition to abdominal discomfort, other symptoms of celiac disease include diarrhea, weight loss, and excessive gas.

Lactose Intolerance

Lactose intolerance is a condition in which a person lacks the enzyme needed to digest the sugars found in dairy products. People with lactose intolerance typically experience diarrhea, gas, or bloating soon after eating foods like milk or cheese.

Lower Gastrointestinal Tract

Here are some of the more common health conditions that arise within the colon and rectum.

Constipation

Constipation is very common and often associated with uncomfortable or even painful abdominal bloating from excess gas. Some people with constipation also have very hard or small stools, increased straining, or a feeling that their bowels do not completely empty.

Diverticulosis

Diverticulosis refers to the development of little pouches within the lining of the colon. Infection and inflammation (called diverticulitis) may lead to symptoms ranging from lower abdominal tenderness to severe pain, fever, nausea, and vomiting.

Appendicitis

The most common symptom of appendicitis is abdominal pain, which usually begins as a dull ache around the belly button. Over time, the pain moves to the lower-right part of the abdomen and becomes sharp. Other associated symptoms include a loss of appetite, nausea and vomiting, and fever. 

Both GI Tracts

Some health conditions that cause perceived stomach pain may affect both the upper and lower digestive system.

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, manifests with a wide range of gastrointestinal and non-gastrointestinal symptoms. The hallmark symptoms of Crohn's disease include crampy abdominal pain along with non-blood diarrhea, while the cardinal symptoms of ulcerative colitis include colicky abdominal pain and bloody diarrhea.

Keep in mind that, while Crohn's disease may affect the entire GI tract from mouth to anus, ulcerative colitis only affects the lower GI tract (colon and rectum).

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is characterized by a cluster of symptoms (including crampy stomach pain, constipation, or diarrhea) for which there is no evidence of underlying damage.

Abdominal Hernia

An abdominal hernia, which may cause stomach pain and a visible bulge, occurs when fatty tissue or an organ poke through a weak or torn area within the abdominal wall. There are different types of abdominal hernias; for example, an umbilical hernia occurs around the belly button, while an epigastric hernia occurs above the belly button. In men, inguinal hernias (near the groin) are the most common.

Cancer

While less common, upper and lower abdominal pain may be a sign of cancer (such as of the ovaries, pancreas, stomach, colon, or liver). Be sure to see your healthcare provider if your pain is persistent or you are experiencing other unusual symptoms like a change in bowel habits, blood in your stool or urine, excessive fatigue, or unexplained weight loss.

When to See a Healthcare Provider

If you ever have sudden and severe stomach pain, seek immediate medical treatment. Other symptoms that warrant getting medical attention right away include:

• Chest pain
• Vomiting up blood or dark-colored flecks
• Having black, maroon, or bloody stools
• Severe and/or persistent constipation
• New-onset pain or swelling around an abdominal hernia site
• Dizziness and/or feeling faint
• Inability to keep down food or fluids

Diagnosis

Aside from going over a thorough medical history with you, your healthcare provider will perform a physical examination that entails listening to your abdomen with a stethoscope and pressing on different areas to evaluate for tenderness or abnormalities like swelling, rigidity, or masses.

Unless your healthcare provider has a feeling that something serious is going on or notes red flags in your medical history or physical exam (e.g. pain that is severe, localized, persistent, or associated with worrisome symptoms like a high fever), they may not proceed with other diagnostic tests right away.

For example, if your healthcare provider strongly suspects constipation, they will likely avoid further testing and instead proceed with management suggestions such as adopting dietary strategies (e.g., increasing fiber and water intake) or trying an over-the-counter laxative. Likewise, if your healthcare provider suspects a run-of-the-mill stomach bug, they will likely proceed with advice on hydration and electrolyte repletion.

In both of these example scenarios, though, it's important to leave the healthcare provider's appointment with a clear understanding of the circumstances under which you should return immediately for another medical evaluation.

Moving forward, if your healthcare provider decides they need more information to get to the bottom of your pain, they will likely proceed with a blood and/or imaging test.

Blood Tests

Depending on your suspected condition, your healthcare provider may order one of many blood tests.

For example, if your healthcare provider suspects gallstones, you will undergo a liver function and bilirubin blood test.

Other blood tests that may be ordered include:

• An antibody blood test called IgA tissue transglutaminase for suspected celiac disease
• Complete blood count and inflammatory markers, like C-reactive protein (CRP) for suspected inflammatory bowel disease
• Pancreatic enzymes (amylase and lipase) for suspected pancreatitis

For a diagnosis of peptic ulcer disease, your healthcare provider will want to test you for H. pylori infection. You may be tested for H. pylori through an endoscopic biopsy of the stomach (performed during upper endoscopy; see below), a urea breath test, or a stool H. pylori antigen test.

Imaging

Several imaging tests may be used to evaluate the "why" behind your stomach pain, including an abdominal ultrasound and a computed tomography (CT) scan. Two other tests you may not be as familiar with include a barium swallow test and an upper endoscopy.

Barium Swallow

The barium swallow test is an X-ray imaging test sometimes used to evaluate disorders of swallowing, stomach ulcers, and hiatal hernia. During this test, a person drinks a thick liquid called barium while X-rays are taken, allowing the esophagus and stomach to be visualized clearly.

Upper Endoscopy

In order to confirm a suspected or potential diagnosis, your healthcare provider may refer you to a gastroenterologist (a healthcare provider who specializes in treating diseases of the digestive tract) for an upper endoscopy.

During an upper endoscopy, while you are sedated, a gastroenterologist inserts a long tube with a camera attached to it into your mouth and down through your esophagus into your stomach. During this test, your healthcare provider visualizes the inside of your upper digestive tract and looks for abnormalities, and can also use surgical tools passed through the tube to take a biopsy (tissue samples).

Differential Diagnoses

To further complicate matters, it's possible to have what you think of as stomach pain that doesn't stem from the GI tract at all, but rather from another system.

For example, stomach pain can be easily confused with chest pain. In the event of unexplained chest pain or stomach pain without other classic gastrointestinal symptoms, heart disease absolutely needs to be considered. In this case, an electrocardiogram, exercise stress test, and cardiac enzymes may be ordered.

Pelvic pain can also be confused for lower stomach or abdominal pain, and it can be caused by a urinary tract infection, an ovarian cyst rupture or torsion, pelvic inflammatory disease, endometriosis, fibroids, a kidney stone or infection, ectopic pregnancy, among other causes.

Likewise, upper stomach or abdominal pain could stem from the lungs and might be a symptom of pneumonia or pulmonary embolism.

Treatment

As you probably expect, the treatment of stomach pain depends on the underlying diagnosis.

Lifestyle Treatment Options

Several lifestyle modifications may help manage your condition. For example, in the case of celiac disease, a strictly gluten-free diet is essential to treatment, just as restricting lactose (milk products) ingestion is how most people manage lactose intolerance.

Treating GERD may require several lifestyle changes, such as:

• Losing weight if you are overweight or recently gained weight
• Elevating the head of your bed (for example, placing a foam wedge underneath the top of the mattress)
• Avoiding meals two to three hours before going to bed

Lifestyle behaviors are also at the crux of treating constipation.

They include:

• Eating foods high in fiber, such as prunes and breakfast cereals
• Drinking six to eight glasses of water per day
• Engaging in daily physical activity

These are just a few of many examples.

Medications

Some gastrointestinal-related conditions can be managed with over-the-counter or prescription medications.

Acid-Reducing Medications

While your run-of-the-mill occasional heartburn may be treated with over-the-counter antacids like Tums, Maalox, and Mylanta, the treatment of GERD, peptic ulcer disease, and gastritis requires taking a medication called a histamine blocker or a proton pump inhibitor.

Laxatives

For constipation-related stomach discomfort, laxatives may be recommended by your healthcare provider, particularly if lifestyle changes are not helping. Be sure to discuss which laxative to take with your healthcare provider, as they work differently and some may not be safe for you.

Antibiotics

For infectious-related sources of abdominal pain, like diverticulitis or for the management of H. pylori (when it is the culprit behind a person's gastritis or peptic ulcer disease), antibiotics will be prescribed. While oral antibiotics for H. pylori and mild diverticulitis can be taken at home, moderate-to-severe cases of diverticulitis require hospitalization with antibiotics given through the vein.

Steroids and Immunosuppressants

Treatment of inflammatory bowel disease may involve steroids and immunosuppressants to slow the progression of the disorder.

IBS Medications

Treatment of IBS is complex and may entail taking one or more medications, depending on a person's unique symptoms. While not an exhaustive list, some medications used to ease the symptoms of IBS include:

• Anti-diarrheal drugs like Imodium (loperamide)
• Anti-constipation drugs like Miralax (polyethylene glycol)
• Anti-spasmodics like Bentyl (dicyclomine)
• Tricyclic antidepressants like Elavil (amitriptyline)

Surgery

While surgery is the first-line treatment for some gastrointestinal conditions, such as appendicitis, symptomatic gallstones, and abdominal wall hernias, it may be the last resort option for other gastrointestinal problems. For example, a surgery called a Nissen fundoplication may be recommended for refractory GERD.

Surgery may also be indicated for complications that occur as a result of a gastrointestinal condition—for instance, a perforated peptic ulcer (when a hole forms in the stomach or small intestines) or abscess formation in acute diverticulitis.