Epigastric pain in adults : Differentials

Epigastric pain in adults is a common yet complex clinical presentation, often posing a diagnostic challenge to primary care clinicians. The epigastric region, anatomically located just below the ribcage and above the umbilicus, is the seat of several vital organs, including the stomach, duodenum, pancreas, and parts of the liver and biliary tract. Pain in this area can indicate a broad spectrum of conditions ranging from benign, self-limiting disorders to acute, life-threatening emergencies.

Understanding the intricate anatomy of the epigastric region is crucial for clinicians. The proximity of the gastrointestinal, pancreaticobiliary, vascular, and sometimes cardiac structures within this confined space means that symptoms can overlap, and differentiating between causes requires a keen clinical acumen. Conditions such as gastritis, peptic ulcer disease, pancreatitis, and gallstone-related pathology often manifest as epigastric pain and are considered in the differential diagnosis. Vascular issues like aortic dissection and mesenteric ischemia, although less common, are critical not to miss. Moreover, cardiac events like angina or myocardial infarction can sometimes present with epigastric pain, emphasizing the need for a comprehensive evaluation.