Upper Abdominal Pain Above the Navel: Causes and Next Steps

Q: Upper Abdominal Pain Above the Navel: Causes and Next Steps

Hello： After undergoing gastroscopy, colonoscopy, and ultrasound without finding any specific issues, it is important to consider functional problems, such as spasms or gastroesophageal reflux that does not cause esophagitis, as well as bloating and dyspepsia. <br>It may be benef

Tenderness above the umbilicus, normal findings on gastroscopy?

Hello, doctor.
I am a 30-year-old male office worker who sits for long periods.
My symptoms include tenderness in the abdomen, specifically at a small point just above the navel and just below the xiphoid process.
Pressing on this area causes pain, but I usually don't feel anything when I'm not pressing on it.
There are no accompanying symptoms such as fever, dizziness, or nausea, and my bowel movements are normal.
The episodes are not consistent; they don't occur every day but are more frequent during the day, particularly after breakfast or lunch.
The duration of the pain varies, but it usually improves gradually after dinner until I go to bed.
I have done some self-assessment of my diet, but it seems that both light foods like plain toast and heavier meals can trigger the symptoms.
Three weeks ago, I visited a gastroenterologist, and the gastroscopy results were normal (with no bacterial cultures found), and my blood tests were also normal.
The doctor prescribed some medications to relieve gastrointestinal motility, but I feel they haven't been effective.
Additionally, I had an abdominal ultrasound during a health check-up a year ago, which was normal, and a colonoscopy two years ago, which was also normal.
I would like to ask if there are any immediate tests that need to be performed for my situation, or should I continue taking the medication, monitor my diet and lifestyle, and observe my condition for a few more months?

YAZOO, 30~39 year old female. Ask Date: 2017/10/26

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: After undergoing gastroscopy, colonoscopy, and ultrasound without finding any specific issues, it is important to consider functional problems, such as spasms or gastroesophageal reflux that does not cause esophagitis, as well as bloating and dyspepsia.
It may be beneficial to modify your lifestyle and dietary habits.
Try to reduce the intake of tea, coffee, soda, chocolate, sweets, glutinous rice products, high-fat/high-protein foods, avoid overeating, smoking, drinking alcohol, chewing betel nut or gum, managing stress, and addressing issues related to being overweight or underweight, as these factors can contribute to your symptoms.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2017/10/26

More Info

Upper abdominal pain, particularly localized above the navel and below the sternum, can be attributed to a variety of causes. Given your age and lifestyle as a sedentary office worker, it’s essential to consider both gastrointestinal and musculoskeletal factors that could be contributing to your discomfort.

Potential Causes
1. Gastritis or Peptic Ulcer Disease: Inflammation of the stomach lining (gastritis) or the presence of ulcers can lead to localized pain, especially after meals. While your endoscopy showed normal results, gastritis can sometimes be present without visible lesions.

2. Functional Dyspepsia: This is a common condition characterized by chronic or recurrent pain in the upper abdomen. Symptoms can include discomfort after eating, bloating, and early satiety. It often requires a trial of dietary changes and medications to manage.

3. Gallbladder Issues: Although your ultrasound was normal, gallbladder disease can sometimes present with intermittent pain, especially after fatty meals. Conditions like biliary colic may not always show up on imaging.

4. Musculoskeletal Pain: Given your sedentary lifestyle, muscle strain or tension in the abdominal wall could be a factor. This type of pain may be exacerbated by certain movements or positions and can be mistaken for gastrointestinal discomfort.

5. Pancreatitis: While less likely given your normal blood tests and imaging, pancreatitis can cause upper abdominal pain that may radiate to the back. This is typically associated with other symptoms, such as nausea or changes in bowel habits.

Next Steps
1. Dietary Modifications: Since your symptoms seem to correlate with meal times, keeping a detailed food diary may help identify specific triggers. Consider trying a low-fat diet temporarily to see if symptoms improve.

2. Medication Review: If the medications prescribed for gastrointestinal motility are not effective, it may be worth discussing alternative treatments with your physician. Proton pump inhibitors (PPIs) or H2 blockers could be beneficial if gastritis or acid-related issues are suspected.

3. Further Testing: If symptoms persist despite dietary changes and medication, further evaluation may be warranted. This could include:
- Abdominal Ultrasound: To rule out gallbladder disease or other structural issues.

- CT Scan: If there’s a concern for pancreatitis or other abdominal pathology.

- Endoscopic Ultrasound: If gallbladder or pancreatic issues are suspected but not confirmed by standard imaging.

4. Lifestyle Changes: Incorporating regular physical activity can help improve gastrointestinal motility and reduce stress, which may contribute to your symptoms. Aim for at least 30 minutes of moderate exercise most days of the week.

5. Follow-Up: Regular follow-up with your healthcare provider is crucial. If your symptoms worsen or new symptoms develop (such as weight loss, persistent vomiting, or changes in bowel habits), seek immediate medical attention.

Conclusion
While your symptoms may not indicate a severe underlying condition, ongoing discomfort warrants further investigation and management. By monitoring your diet, adjusting your lifestyle, and maintaining open communication with your healthcare provider, you can work towards identifying the root cause of your pain and finding effective relief.

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