Central upper abdominal pain… The true cause lies elsewhere.

Hello. This is Baengnokdam Korean Medicine Clinic.

Today, let's talk about situations like, 'My epigastric area hurts, but tests at the hospital show nothing abnormal.'

Hearing that tests show nothing abnormal often makes you more anxious, not relieved.

"Then what is this pain?"

"Is it a nerve issue?"

"Could it be something serious like cancer?"

These worries inevitably follow. However, pain in the central upper abdomen, commonly known as 'epigastric pain,' is actually a fairly common symptom that can occur even without any organic underlying issues. Today, we'll delve into some often-overlooked causes and discuss what clues to look for in your daily life.

1. What is the 'Myungchi' (Epigastric Area)?

First, let's clarify its location. What we commonly refer to as 'myungchi' is medically known as the central upper abdomen, or the Epigastric area. This is the area just below the end of the sternum, where the rib cage separates. Pain in this area can be related to a wide variety of organs: the stomach, duodenum, pancreas, gallbladder, heart, and even the muscles of the abdominal wall itself. Therefore, pinpointing the exact cause can be challenging.

2. Epigastric Pain, But Normal Test Results?

In such cases, you must consider the following three possibilities:

1. Gastrointestinal conditions that are difficult to detect on tests.For example, early gastritis, gastroesophageal reflux (GERD), gallbladder dyskinesia, or early pancreatic dysfunction can all appear normal on endoscopy or CT scans. Specifically, even without inflammation, subtle acid reflux in GERD can cause heartburn or a feeling of discomfort/pressure in the epigastric area. Yet, tests come back 'normal'.
2. Functional gastrointestinal disorders (Functional Dyspepsia).Simply put, this means the organ structure is normal, but its movement, nerve sensation, or acid response is overly sensitive. Functional dyspepsia is broadly divided into two types.In these cases, no matter how many tests are repeated, nothing abnormal is found. However, the symptoms are distinct. They manifest as a feeling of fullness after meals, frequent burping, a heavy feeling in the stomach right after waking up, and so on.
   • PDS type (Postprandial Distress Syndrome): Characterized by bloating and a feeling of being unable to eat more after meals.
   • EPS type (Epigastric Pain Syndrome): Characterized by sharp, piercing pain when hungry, which worsens with stress.
3. Autonomic nervous system issues.If the sympathetic nervous system is overly excited or the vagus nerve's regulatory function is weakened, the balance of gastric motility and acid secretion is disrupted. Simply put, symptoms like "my stomach hurts when I'm nervous" or "I feel nauseous when stressed" all fall into this category. There are no physical lesions, but the gastrointestinal tract overreacts due to an imbalance in nervous system regulation.

3. When Does the Pain Occur? That's the Real Clue.

This is the key. Observing 'in what situations the pain occurs' can help estimate the cause.

• Pain immediately after meals → Acid reflux, gallbladder issues, functional dyspepsia (PDS type)
• Pain when hungry → Gastritis, ulcers, functional dyspepsia (EPS type)
• Worsens with stress → Autonomic nervous system issues, nervous gastritis
• Worsens when lying down or bending over → Possible GERD
• Pain when moving and upon palpation → Abdominal wall pain, myofascial pain possible

Instead of relying on a few questions from a doctor, meticulously keeping a symptom diary for a few days can provide much stronger clues.

4. The Best Way to Keep a Symptom Diary

Record the following items daily:

• When the pain started (time)
• What you ate before the pain
• How much you ate
• Whether you were stressed
• What your posture was (sitting, lying down, during activity, etc.)
• What made it better (warm compress, antacids, sleep, etc.)

If you keep this for just 3 to 5 days, a clear pattern will emerge. You might realize, "Ah, I always feel pain when I eat a late-night snack and lie down immediately," or "My stomach feels heavy on days when I'm heavily stressed after work."

5. 'Pattern Recognition' Comes Before Treatment

While pharmacological treatment for symptoms is important, what needs to be done first is observing your body's rhythm.

• Eating habits
• Sleep patterns
• Emotional fluctuations
• Posture habits

These factors are directly linked to stomach tension. Sometimes, a glass of warm water and diaphragmatic breathing can be much more powerful soothing agents than digestive aids.

If epigastric pain recurs and tests show nothing abnormal, it might not mean "there's no illness," but rather "the illness is not visible." We should suspect often-overlooked reasons such as functional gastrointestinal disorders, autonomic nervous system imbalance, and abdominal wall tension. And the clues are always hidden 'within your daily life, within your habits.' Today, I encourage you to take a moment to look into your body's rhythm. Thank you.

#CentralUpperAbdominalPain