In short: Epigastric pain is pain or discomfort in the upper middle part of the tummy, just below the breastbone. It is most often caused by indigestion, acid reflux, gastritis or a stomach ulcer, and frequently settles with simple changes and pharmacy advice. Pain that is severe, comes with chest pain or breathlessness, or with vomiting blood or black stools, needs emergency help.

This guide, written by a Ready Health prescribing pharmacist in Standish, Wigan, explains the common causes, the warning signs to watch for and when to see a GP.

Where is the epigastric area?

The epigastrium is the upper central part of the abdomen, between the bottom of the breastbone and the belly button. Pain here can come from the stomach, the first part of the small bowel (duodenum), the oesophagus (food pipe), the gallbladder, the pancreas or, occasionally, the heart.

What are the common causes of epigastric pain?

Cause	Typical features
Indigestion (dyspepsia)	Burning or full feeling after eating, bloating, belching
Acid reflux and GORD	Heartburn rising into the chest, sour taste, worse lying down or bending
Gastritis	Inflamed stomach lining, often linked to alcohol, anti-inflammatory painkillers or H. pylori infection
Stomach or duodenal ulcer	Gnawing or burning pain, sometimes eased or worsened by food
Gallstones	Severe pain in the upper middle or right of the tummy, often after fatty meals, lasting hours
Pancreatitis	Severe, constant pain often spreading to the back, with vomiting; needs hospital care
Epigastric hernia	A small lump in the midline above the belly button, which may ache on straining

Medicines are a common contributor. Anti-inflammatory painkillers such as ibuprofen, naproxen and aspirin can irritate the stomach and cause ulcers, especially in older people or with long-term use.

When is epigastric pain an emergency?

Call 999 or go to A&E if you have:

chest pain, or upper tummy pain with breathlessness, sweating, feeling faint, or pain spreading to the arm, jaw, neck or back (this can be a heart attack)
vomit with blood in it or that looks like coffee grounds
black, sticky or tarry stools
sudden, severe tummy pain, or a tummy that is rigid and very tender
severe pain with yellowing of the skin or eyes, or a high temperature

When should you see a GP?

Book a GP appointment if:

indigestion or upper tummy pain keeps coming back or does not improve with pharmacy treatment and lifestyle changes
you have lost weight without trying
you have difficulty swallowing or food sticks
you keep being sick
you have signs of anaemia, such as tiredness, breathlessness or pale skin
you feel a lump in your tummy

The NICE guideline on suspected cancer (NG12) advises an urgent camera test (endoscopy) for people with difficulty swallowing, and for people aged 55 and over who have lost weight and also have upper tummy pain, reflux or indigestion. Stomach and oesophageal cancers are uncommon, but these symptoms should not be ignored.

How is epigastric pain treated?

Treatment depends on the cause. For uncomplicated indigestion and reflux, common first steps are:

eating smaller meals and avoiding eating within 3 to 4 hours of bedtime
cutting down on alcohol, caffeine, and rich, fatty or spicy foods if they trigger symptoms
stopping smoking and, if relevant, losing weight
raising the head of the bed slightly if symptoms are worse at night
asking a pharmacist about antacids or other over-the-counter treatments, and reviewing any anti-inflammatory painkillers

If symptoms persist, a clinician may test for H. pylori (a breath or stool test), check blood tests, and consider prescribed treatment or further investigation. Any prescription is decided by a prescriber after assessing you.

Frequently asked questions

Can stress cause epigastric pain?

Stress and anxiety can make indigestion and reflux feel worse, but new or persistent pain should still be assessed rather than put down to stress.

How is H. pylori tested?

Usually with a breath test or a stool test. Some medicines that reduce stomach acid can affect results, so you may be asked to stop them for a period beforehand.

Can heart problems feel like indigestion?

Yes. Particularly in older people, people with diabetes and women, a heart attack can feel like upper tummy discomfort. If in doubt, call 999.

Should I take ibuprofen for stomach pain?

No. Anti-inflammatory painkillers can make stomach pain and ulcers worse. Ask a pharmacist for advice.

Key takeaways

Epigastric pain is usually caused by indigestion, reflux, gastritis or ulcers.
Chest pain, vomiting blood, black stools or sudden severe pain need emergency help.
See a GP if symptoms persist, or with weight loss, swallowing problems or repeated vomiting.
Anti-inflammatory painkillers are a common, avoidable cause.

Sources and further reading

Last reviewed: October 2026 by Shamir Patel, Independent Prescribing Pharmacist, Ready Health. This article is general information and does not replace advice from your own clinician.

If you have ongoing upper tummy pain and would like a private assessment, you can book one of our private GP appointments in Standish, Wigan.