The Showcase Magazine - Articles


By Cory Vergilio, MD

Upper abdominal pain can be caused by many conditions, related to problems with the esophagus (GERD), gallbladder, stomach, pancreas, or other non-digestive problems, such as heart or musculoskeletal problems. It is important to remember that any persistent complaint should be checked out by a health care professional right away, since symptoms are not always as they appear, and can possibly be a sign of a serious problem. One cause of upper abdominal pain is known medically as non-ulcer dyspepsia; it is more commonly known as indigestion. It is important to note that this describes an extremely common set of symptoms and is by no means always related to a single disease or condition.

Non-ulcer dyspepsia affects as much as thirty percent of adult individuals and is responsible for a large number of physician office visits every year. It has many possible causes, some of which are easily diagnosed and others that are harder to pin down Non-ulcer dyspepsia is usually described as a persistent or recurrent abdominal pain located in the upper abdomen and that occurs either intermittently or continuously for a month or more. One also experiences feelings of bloating and nausea that often occurs after meals.

This condition differs from gastroesophageal reflux disease (GERD) in which symptoms result from the "backup" of acid contents into the esophagus. The feeling of heartburn, or pain that rises up into the chest is almost always associated with GERD but not necessarily with non-ulcer dyspepsia. Irritable bowel syndrome can also cause abdominal pain, but this pain is usually more generalized and is often associated with or relieved by bowel movements, which is not usually a finding in non-ulcer dyspepsia. Pain associated with the gallbladder or biliary tree is usually more localized to the right upper abdomen and is sharper and "colicky." These are not hard and fast rules, however, and consultation with your health professional is always the safest course. Non-ulcer dyspepsia is very common but tends to be somewhat episodic. Men and women are affected about equally. Symptoms of non-ulcer dyspepsia tend to come and go with long periods of time occurring without symptoms. 

There has been much research about the connection between a gastric (stomach) infection by a bacterium called Helicobacter pylori (H. pylori) and dyspepsia. While H. pylori is known to be a major cause for peptic ulcer disease and, therefore, a direct cause for dyspepsia, its relationship to pain in the absence of ulcer disease is not clear. 

Physicians often use testing such as upper endoscopy, upper GI series, or ultrasound to help exclude either ulcers or gallbladder disease prior to considering non-ulcer dyspepsia, which is often considered a diagnosis of exclusion. Less common causes of abdominal pain, including diseases of the pancreas, gallbladder and liver, as well as very unusual causes such as lung clots, heart attacks or aneurysms of the aorta, are often considered, making evaluation by one's health care professional very important. Evaluation can often lead to a better narrowing down of the diagnosis and subsequently more focused and effective treatment for the myriad of causes of upper abdominal pain.

Dr. Cory Vergilio is a partner and gastroenterologist at Digestive Healthcare Center (DHC). DHC offers a comprehensive infusion therapy center to effectively treat patients living with gastrointestinal conditions where oral medication isn�t an option. The infusion therapy center has specialty-trained nurses and friendly staff to ensure that all infusion patients have an optimal experience.