Epigastric pain (dyspepsia, upper abdominal pain)

DDx

Don’t miss

  • Pancreatitis
  • Cholangitis
  • Myocardial ischemia
  • Pneumonia
  • Abdominal hernia
  • Pregnancy
  • Intestinal ischemia

DDX

  • Functional or nonulcer dyspepsia (most common)
  • Peptic ulcer disease
  • Gastroesophageal reflux
  • Gastritis, eg, NSAIDs, alcohol, stress, H. pylori, pernicious anemia
  • Pancreatitis or pancreatic cancer
  • "Indigestion" from overeating, high-fat foods, coffee
  • Other drugs: aspirin, antibiotics (eg, macrolides, metronidazole), corticosteroids, digoxin, narcotics, theophylline
  • Gastroparesis
  • Lactase deficiency
  • Malabsorption
  • Gastric cancer
  • Parasitic infection, eg, Giardia, Strongyloides, Ascaris
  • Cholelithiasis, choledocholithiasis, or cholangitis
  • H. pylori (controversial)
  • Myocardial ischemia or pericarditis
  • Pneumonia
  • Abdominal hernia
  • Pregnancy
  • Intestinal ischemia
  • Esophageal rupture
  • Gastric volvulus
  • Physical or sexual abuse

See related DDx

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Last updated: February 24, 2015

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