Sharp Pain In The Upper Stomach: 8 Causes & How To Differentiate.
Sharp pain in the upper stomach pain can originate from organs inside your abdomen or your chest. The most common cause of sharp upper stomach pain is gastritis and peptic ulcer disease. The most dangerous cause is heart attacks. Always consult your doctor if you have sharp intolerable pain.
Common causes of sharp upper stomach pain include:
- Peptic Ulcer disease.
- heart attack (Angina Pectoris or myocardial infarction).
- Gallbladder pain.
- GERD and hiatus hernia.
- Surgical causes include abscess or rupture, or infarction of an abdominal organ.
- Other less common causes include pericarditis, IBS, IBD, Familial Mediterranean fever, and stomach, liver, spleen, and pancreas tumors.
Gastritis is the inflammation of your stomach wall. Acute and chronic gastritis are the most common causes of sharp upper stomach pain.
Gastritis is commonly caused by:
- Faulty diet habits: such as spicy, high fat, alcohol, caffeine, and acidic foods.
- NSAIDs abuse: such as Aspirin, Ibuprofen, and Diclofenac.
- H. Pylori infection: a stomach bug that causes gastritis and stomach ulcers.
- Acute gastritis (due to stomach flu): is usually caused by viruses such as norovirus and rotavirus, causing sharp upper and lower stomach pain and diarrhea.
Symptoms (How to suspect gastritis):
- The Upper stomach pain is sharp, continuous, in the form of heaviness or gnawing.
- Related to meals: the pain usually starts shortly after meals (especially heavy or fatty meals).
- The pain can be referred to as the upper-middle back.
- Associated with nausea, lost appetite, or vomiting.
- In severe cases, an ulcer can occur (peptic ulcer).
- Gastritis can be chronic (the pain comes and goes for long periods) or acute (with sudden sharp upper abdominal pain).
- The most common cause of acute gastritis is NSAID drugs and the infection with stomach viruses (Norovirus and rotavirus).
2- Peptic Ulcer Disease.
A peptic ulcer is a breakdown in the lining of your stomach (stomach ulcer) or duodenum (duodenal ulcer).
Peptic ulcer disease is a complication of gastritis. It shares the same causes and symptoms of gastritis plus:
- The upper stomach pain is usually sharper and more severe.
- Nausea and vomiting are more common.
- Bleeding ulcers can lead to vomiting of blood (hematemesis).
- Bleeding can also occur without vomiting blood. The presentation may be dark, tarry stools (melena).
- Also, the bleeding can be scanty over long periods. This leads to anemia (with fatigue, dizziness, and shortness of breath).
CAUTION: A bleeding peptic ulcer is a medical emergency. Call your doctor immediately if you vomit blood or pass black stools with sharp upper stomach pain.
3- Gallbladder Attack.
Your gallbladder can inflame with gallstones (calcular cholecystitis) or without gallstones (Non-calculator cholecystitis).
Symptoms (How to suspect):
- The pain comes in attacks (usually lasts for 4-6 hours).
- The pain suddenly starts and becomes sharp and steady. It comes and goes in waves multiple times.
- The pain usually radiates to the back and the back of the right shoulder.
- The pain is commonly in your upper right stomach but can be central (in the upper middle abdomen).
- The pain usually starts after large or fatty meals (usually after one hour).
- Gallbladder pain is usually associated with severe nausea.
- Vomiting and fever occur in severe cases.
The pancreas releases digestive enzymes to break down and digest food. When it inflames, the digestive enzymes start digesting the pancreas itself.
Pancreatitis can be acute or chronic. Both forms lead to sharp upper stomach pain. Pancreatitis can lead to serious complications if left undiagnosed or untreated.
The most common causes of pancreatitis are the obstruction of its duct by a stone, alcoholism, and elevated blood lipids (triglycerides).
Symptoms (how to suspect pancreatitis).
- The main symptom is sharp abdominal pain in the upper central stomach area.
- The pain starts as dull, boring, and steady. Then, the pain gradually intensifies until reaching a constant sharp ache.
- The pain usually refers to the middle back (approximately 50% of cases).
- The pain becomes less intense on leaning forward.
- The pain intensity may increase after lying on the left or the right side (depending on which part of the pancreas is involved).
- Pancreatitis pain is associated with severe nausea, vomiting, and lost appetite.
- Eating dramatically worsens the condition.
- A history of gallstones, alcoholism, or increased blood lipids (triglycerides) increases the odds of pancreatitis.
- Fever is common with acute pancreatitis.
CAUTION: Pancreatitis is a medical emergency. Seek emergency medical help if your symptoms are suspicious of pancreatitis.
MORE: Can you Die from Acute Pancreatitis: 6 Facts & Statistics.
5- Heart Attack (Anginal attack).
Decreased blood supply to your heart muscle is called myocardial ischemia. It is usually caused by a partial or complete obstruction of the arteries supplying your heart muscle (the coronary arteries).
Myocardial ischemia of the lower part of your heart muscle can lead to sudden sharp abdominal pain. Upper abdominal pain can occur with or without chest pain.
The risk factors of Myocardial ischemia are:
- Being male.
- Being older (typically over 40 years) can occur at younger ages).
- Diabetes Mellitus or hypertension.
- High blood lipids (cholesterol and triglycerides).
- Lack of physical activity.
Symptoms (how to suspect myocardial ischemia as a cause of sharp upper stomach pain):
- The sharp abdominal pain is usually associated with chest pain in the form of pressure or heaviness in the chest and upper stomach area.
- BUT, sharp upper stomach pain can be the only presenting symptom of a heart attack.
- The pain is NOT related to meals. Usually, it suddenly presents with or without physical or mental stress.
- The pain may spread to the lower jaw, left shoulder, and left arm.
- Nausea is common. Vomiting can also occur.
- Shortness of breath.
- Fatigue, lightheadedness, and Sweating are common.
- The more risk factors you have (mentioned above), the more risk of myocardial ischemia.
CAUTION: Sharp upper stomach pain can indicate a heart attack. An emergency medical condition. Seek emergency medical help or call 911 if you suspect a heart attack.
6- GERD & hiatus hernia.
GERD (Gastroesophageal Reflux Disease) is the stomach acid reflux to your esophagus. GERD (chronic acid reflux) is usually caused by a weakness in the sphincter between the stomach and the esophagus or due to a hiatus hernia.
Hiatus hernia is the protrusion of the stomach through the esophageal opening of the diaphragm.
The cardinal symptom of GERD and hiatus hernia is heartburn. But both hiatus hernia and GERD can lead to sharp upper stomach pain (but uncommon).
Symptoms (how to suspect):
- Heartburn: a burning sensation in the chest and upper stomach area due to stomach acid reflux into your esophagus.
- The sharp pain is usually related to meal ingestion (Particularly large fatty meals).
- Regurgitation of foods or liquids into your throat or mouth.
- Chest pain or discomfort and shortness of breath are common with a hiatus hernia.
- Nausea, vomiting, and lost appetite.
- Difficulty swallowing can occur with the hiatus hernia.
7- Other surgical causes of sharp upper stomach pain:
Sharp pain is usually a warning sign from your body. Sharp pain, especially if progressive or persistent, usually requires you to seek medical help.
Some conditions can lead to sharp pain that may require surgical intervention.
- A perforation in a hollow organ: such as a stomach perforation, duodenal ulcer perforation, colon or small intestine perforation, rupture of gallbladder or appendix.
- An Abscess: splenic abscess, liver abscess, abscess around the liver or under the diaphragm, lower lung abscess.
- Intestinal Obsturction.
- Mesenteric vascular ischemia.
- Trauma to an internal organ: such as the liver or splenic injury.
- Aortic dissection.
- Infarction (death) of an internal organ: such as splenic infarction.
The pain is usually very intense and associated with severe intolerable tenderness. Fever, vomiting, and nausea are common with such conditions.
8- Less Common Causes
A- Irritable Bowel Syndrome (IBS) and inflammatory bowel diseases (IBD).
Irritable bowel syndrome (IBS) is a functional gut disease. It presents with abdominal pain (which can be sharp) associated with defecation and changes in bowel habits.
It is non-typical for Irritable bowel syndrome to cause sharp upper stomach pain. However, it is a widespread disease affecting up to 30% of the population (ref).
From our clinical experience, Some extreme varieties of IBS can present with sharp pain (which can affect the upper stomach area).
However, IBS is not considered a primary cause of sharp upper stomach pain. We consider IBS only after excluding all the possible conditions that can lead to such a condition.
Inflammatory bowel disease includes Ulcerative colitis (UC) and Crohn’s disease. They’re characterized by inflammation and ulcers involving part of or the whole gut tract.
Ulcers and transverse colon inflammation may present with sharp upper stomach pain.
Pericarditis is swelling and irritation of the pericardium (a think sac-like tissue surrounding your heart. It usually causes sharp chest pain and may be associated with sharp upper stomach pain. Learn more.
C- Cancers of the liver, stomach, or spleen.
Tumors involving organs in the upper part of your abdomen can present with a sharp pain in the stomach area.
Common Tumors include:
- Primary liver cell cancer (Hepatocellular carcinoma).
- Metastatic liver cancers (secondary to tumors elsewhere).
- Pancreatic cancer.
- Stomach cancer.
- Biliary cancer (cholangiocarcinoma)
- Splenic focal lesions and blood malignancies involving the spleen.
F- FMF (Familial Mediterranean Fever).
Familial Mediterranean fever is a genetic disorder that causes recurrent attacks of sharp abdominal pain, fever, and joint and lung inflammations.
FMF usually affects people of Mediterranean origin (North Africans, Jewish, Arab, Armenian, Turkish, Greek, and Italians).
FMF comes in attacks of one to three days. Symptoms suddenly start and suddenly disappear.
Symptoms (how to suspect):
- Sudden sharp abdominal pain. The pain may affect the whole abdomen or localize in a specific area (such as the upper stomach).
- Fever usually occurs during the attack.
- Muscle aches.
- Joint swelling and pain.
- Muscle aches.
- Chest pain.
- The symptoms are not related to meals. Come and go abruptly.
When to see a doctor:
Undiagnosed sharp upper stomach pain alone is an indication to see your doctor. The condition is urgent when:
- The pain is extremely severe or prolonged.
- The pain awakens you at night.
- Extreme tenderness on touching your stomach.
- Vomiting: especially if severe or containing blood (hematemesis).
- Associated chest pain or heaviness.
- Bloody or blackish stool or diarrhea.
- Prolonged pain with weight loss.
- Jaundice (yellowish discoloration of the skin or the eye whites).
- Difficulty swallowing.
FAQs about sharp upper stomach pain:
1- What causes sharp pain in both the upper stomach and back?
Sharp upper stomach pain in the back is caused by gastritis, peptic ulcer disease, cholecystitis, biliary colics, myocardial ischemia, and, more importantly, pancreatitis. Also, kidney stones can cause pain referred to as the back but rarely causes upper stomach pain.
2- What causes waves of sharp pain in the upper stomach that comes and go?
As with IBD and IBS, the common causes of upper stomach pain that come and go in waves are gallbladder pain, inferior myocardial ischemia, gastritis, GERD, and colon pain. On the other hand, conditions like pancreatitis and malignancies are usually steady and progressive.
3- What causes sharp upper stomach and chest pain?
Common causes of sharp upper stomach and chest pain are myocardial ischemia (a heart attack), GERD, hiatus hernia, and pericarditis. Less common causes of sharp upper stomach pain that radiates to the chest are gastritis, peptic ulcer disease, gallbladder pain, familial Mediterranean fever, and others.
4- What causes sharp pain in the upper left stomach?
Common causes of sharp upper left stomach pain include gastritis, peptic ulcer disease, gastric malignancy, pancreatitis, and left kidney pain (renal colics). Less common causes include heart attacks, pericarditis, left lung infection, lung abscesses, and diseases affecting the descending colon, such as IBS and IBD.
5- What causes sharp pain in the upper right stomach?
The most common cause of sharp upper right stomach pain is gallbladder pain. Other causes include hepatitis, liver abscess, malignancy, right subphrenic abscess, right pneumonia, right lung abscess, right kidney pain, right colon inflammation, or IBS.
6- what causes sharp pain in the upper stomach when I breathe?
Sharp upper stomach pain that increases with breathing may indicate acute inflammatory conditions inside your abdomen, such as severe gastritis, peptic ulcer, pancreatitis, cholecystitis, intraabdominal abscess, or injury to an organ. Also, it may indicate inflammatory conditions inside your chest, such as pneumonia, pleurisy, esophagitis, pericarditis, and others.
Sharp pain in the upper abdomen that increases with respiratory movement indicates a severe condition. Consult your doctor to get diagnosed.
7- What causes sharp pain in the upper stomach and diarrhea?
Common causes of sharp abdominal pain and diarrhea are acute gastroenteritis, pancreatitis, cholecystitis, Irritable bowel syndrome, Inflammatory bowel disease, food intolerance, Bile acid diarrhea, and acute hepatitis.
8- What causes bloating and sharp pain in the upper stomach?
Gastritis and peptic ulcer disease is the most common cause of bloating and peptic ulcer disease. Other causes include gastroesophageal reflux disease, pancreatitis, cholecystitis, and acute gastroenteritis. Always consult your doctor if the pain is severe or associated with chest pain or vomiting.