Nocturnal Abdominal Pain: Causes and Concerns - Gastroenterology and Hepatology

Q: Nocturnal Abdominal Pain: Causes and Concerns

Hello： If you experience pain in the left side of the epigastric area, especially when lying down to rest, it may be worth considering the possibility of gastroesophageal reflux disease (GERD). <br>Be mindful to avoid irritating foods and beverages (such as tea and coffee), do no

Frequent abdominal pain during the night or early morning?

Hello Doctor: In the past three months, I have experienced abdominal pain 6 to 7 times.
The pain is located in the upper abdomen, specifically in the triangular area inside the rib cage on the left side (near the stomach), where it is particularly severe.
The pain is intense, characterized by a feeling of pressure and distension, occurring mostly after 10 PM or in the early morning.
Before the severe pain, I often feel a period of discomfort with bloating, which lasts for about two hours, after which the pain subsides, leaving only a vague sense of abdominal discomfort (without diarrhea or vomiting).
Three months ago, I might have overindulged during the New Year celebrations, resulting in a day-long episode of pain that left me too weak to do anything and led me to seek help at a family medicine clinic.
The doctor diagnosed it as acute gastritis, and after taking medication for a few days, I felt better and didn't think much of it.
However, the frequency of the pain has increased, and my meal times and daily routine are normal; I rarely overeat and avoid greasy foods.
Since the pain resolves itself, I haven't seen a doctor again.
I would like to ask what possible issues this could indicate.
Thank you.

Addie, 20~29 year old female. Ask Date: 2017/05/03

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: If you experience pain in the left side of the epigastric area, especially when lying down to rest, it may be worth considering the possibility of gastroesophageal reflux disease (GERD).
Be mindful to avoid irritating foods and beverages (such as tea and coffee), do not lie flat while sleeping, and avoid late-night snacks.
If you have any concerns, you can consult a gastroenterologist.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2017/05/03

More Info

Nocturnal abdominal pain, particularly when it occurs in the upper abdomen and is associated with a sensation of fullness or pressure, can be concerning and may indicate several underlying conditions. Given your description of the pain being localized to the left side near the stomach, occurring primarily at night, and lasting for about two hours, there are several potential causes to consider.

1. Gastritis or Peptic Ulcer Disease: Since you mentioned a previous diagnosis of acute gastritis, it is possible that you may be experiencing recurrent gastritis or even a peptic ulcer. These conditions can cause significant discomfort, especially after meals or during the night when the stomach is empty. The pain may be exacerbated by certain foods or stress.

2. Gallbladder Issues: Although your pain is on the left side, gallbladder problems can sometimes present with pain that radiates to different areas of the abdomen. Conditions such as cholecystitis (inflammation of the gallbladder) or gallstones can lead to intermittent pain, particularly after eating fatty meals, which may not be your case since you mentioned avoiding oily foods.

3. Pancreatitis: Inflammation of the pancreas can also cause upper abdominal pain that may be severe and can occur at night. This condition is often associated with alcohol consumption or gallstones, but it can also occur in individuals without these risk factors.

4. Functional Dyspepsia: This is a common condition characterized by chronic or recurrent pain in the upper abdomen without any identifiable organic cause. It can be triggered by stress, dietary habits, or other lifestyle factors.

5. Esophageal Reflux or Spasm: Gastroesophageal reflux disease (GERD) can cause pain that mimics abdominal discomfort, especially if it occurs after eating or when lying down. Esophageal spasms can also lead to significant discomfort that may be mistaken for abdominal pain.

6. Anxiety and Stress: Given your history of anxiety, it is important to consider the role of psychological factors in your abdominal pain. Stress and anxiety can lead to gastrointestinal symptoms, including pain, bloating, and discomfort.

Considering the frequency and intensity of your symptoms, it is advisable to seek further medical evaluation. A healthcare provider may recommend diagnostic tests such as an upper gastrointestinal endoscopy, abdominal ultrasound, or CT scan to rule out any serious conditions. Additionally, they may suggest lifestyle modifications, dietary changes, or medications to manage your symptoms effectively.

In summary, nocturnal abdominal pain can stem from various causes, including gastritis, gallbladder issues, pancreatitis, functional dyspepsia, esophageal reflux, and even anxiety. Given the recurrent nature of your symptoms, it is crucial to consult a healthcare professional for a thorough evaluation and appropriate management. Early intervention can help prevent complications and improve your quality of life.

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