Temporal occurrence of upper abdominal pain
The mere fact that one notices nocturnal upper abdominal pain speaks a little for the intensity of the pain. This is why such upper abdominal pain always requires clarification, especially when the abdomen is hardened at the same time and those affected show defensive tension when touched. Children with nocturnal pain in the upper abdomen should always be monitored for growth and development disorders.
Classical triggers for nocturnal pain are diseases that cause “sobriety pain”, since it is precisely at night that such a state is reached. These include duodenal ulcer (= Ulcus duodeni) but also inflammation of the mucous membrane of the stomach (gastritis). Both show their pain characteristics after a longer period of abstinence from food (usually 4 hours after eating) and are therefore not only called “fasting pain” but also “hunger pain”.
Normally, the acid gastric juice with a pH value of 1 does not cause any problems. However, if there are disturbances in the stomach lining, the acid can irritate it and cause it to become inflamed, so that it is referred to as gastritis. Especially if you have not eaten anything for a long time, or if your dinner was a long time ago, the food in the stomach cannot bind or buffer the acid.
Therefore this type of upper abdominal pain often occurs at night. In order to differentiate between certain clinical pictures, the time when the pain occurs is an important differentiating factor. If patients complain of pain in the upper abdomen after eating, inflammation of the mucous membrane of the stomach (gastritis) is considered to be a diagnosis of exclusion, as the stomach is less acidic after eating and the symptoms are therefore less severe.
In this case, the pain tends to occur before eating, as the stomach acid can attack the stomach lining undisturbed at this time (“hunger pain”/”fasting pain”). To have pain after eating, there must therefore be reasons that cause problems in transporting the food, hinder the processing of the food or are of mechanical origin. The gallbladder is the most common site of pain in the upper abdomen.
This is explained by the fact that after eating, the gallbladder wall muscles contract with the aim of transporting the bile salts through the bile ducts into the intestine. However, if there are gallstones in the gallbladder or bile ducts, the increased movement of these stones causes severe colicky pain. This stabbing pain is particularly noticeable in the right upper abdomen.
Often the cause of upper abdominal pain after eating is relatively harmless, if it rarely occurs at the same time, because one has simply eaten something difficult to digest. Very often flatulence can be a harmless and uncomplicated cause of upper abdominal pain after eating. Certain foods are tolerated differently and can cause individual problems.
Predisposed, however, are generally high-carbonic drinks, pulses, onions and generally very fatty foods. In addition to pain in the upper abdomen, patients often feel full and complain of abdominal cramps and constipation.However, eating too fast and stress can also lead to flatulence. However, if the pain in the upper abdomen occurs regularly and there are additional complaints such as heartburn or increased belching, the suspicion of reflux esophagitis (= reflux disease of the esophagus) is obvious.
A less harmless cause can also be pancreatitis (= inflammation of the pancreas). Acute pancreatitis can be life-threatening and from its chronic form even a carcinoma can develop. Pain in the upper abdomen has a belt-shaped pain characteristic that radiates into the back.
Besides the pain, accompanying symptoms such as nausea, vomiting, fatty stools and weight loss occur. Pain in the upper abdomen typically occurs after eating, because this is when the pancreas, the most important digestive gland, begins its work and secretes digestive enzymes. Upper abdominal pain is a symptom that does not specifically indicate a certain disease.
Rather, the pain must be categorized more precisely in terms of its nature (stabbing, burning, sharp, dull) and its occurrence (permanent, seizure-like, colicky). Furthermore, additional accompanying symptoms can give an indication in a certain direction. If abdominal pain and nausea occur together, however, this too is not yet sufficient for a diagnosis.
A possible cause can be a problem in the stomach area. The pain is then often located in the middle upper abdomen. It could be an inflammation of the stomach lining (gastritis), which can be either acute or chronic.
The nausea is often more a kind of unpleasant feeling of fullness, which patients describe as a bloated stomach. Depending on the type of gastritis, treatment with drugs from the group of proton pump inhibitors (e.g. pantoprazole) can provide relief if the symptoms are permanent. Another cause can be stomach pain after alcohol consumption.
This form of upper abdominal pain is often accompanied by nausea. If it is a chronic type B gastritis, the stomach is bacterially colonized by the germ Helicobacter pylori. In this case, a so-called eradication therapy with a combination of antibiotics and proton pump inhibitors should be used.
An ulcer of the stomach (ulcus ventriculi) or duodenum (ulcus duodeni) can also cause pain in the upper abdomen with accompanying nausea. In the case of duodenal ulcers, the pain often improves after food intake, whereas in the case of peptic ulcer, the pain is more independent of food intake. Depending on the extent of the ulcer, drug therapy can often be sufficient.
Here too, proton pump inhibitors are the drug of choice. They reduce the excessive acid production of the stomach, which is the cause of the ulcer. If Helicobacter pylori colonization is present, eradication therapy should also be used for gastric or duodenal ulcers.
Upper abdominal pain in the middle abdomen accompanied by nausea can also be caused by the pancreas, for example acute or chronic inflammation of the pancreas (pancreatitis). Depending on the severity of the disease, in-patient monitoring and treatment of those affected may be necessary, as pancreatitis can assume dangerous proportions. Pain in the upper abdomen, which tends to be localized in the right upper abdomen and is accompanied by nausea, may indicate a problem with the gallbladder.
Either in the form of an inflammation (cholecystitis) or in the form of a stone (cholecystolithiasis). The pain – and also the nausea – with stones of the gallbladder often increase after eating, because the gallbladder then works harder and the stones start moving. Furthermore, the liver is located in the right upper abdomen, but diseases of the liver in early stages rarely cause complaints such as pain or nausea. Pain in the left upper abdomen can indicate a swelling of the spleen as a result of an infection, but this is rarely accompanied by nausea.