شرح المدرسين
Overview
Epigastric pain is a common presenting symptom in clinical practice, affecting up to 25% of the population and accounting for 5-10% of primary care visits. The approach to epigastric pain is age-dependent, with functional causes predominating in patients <50 years and organic diseases becoming more common after age 60.
The differential diagnosis includes gastrointestinal causes (functional dyspepsia, peptic ulcer disease, GERD), pancreaticobiliary conditions (acute pancreatitis - high-yield for boards), and extra-abdominal causes (myocardial infarction). Pain-food relationships are crucial for differentiating ulcer types: gastric ulcers worsen with food, while duodenal ulcers improve with food.
Definition
- Epigastric pain is discomfort or pain localized to the upper central abdomen (epigastrium), defined as the region below the xiphoid process and above the umbilicus.
Epidemiology
- Prevalence: Affects up to 25% of the population at some point in their lives
- Healthcare utilization: Accounts for 5-10% of primary care visits
- Gender: Functional dyspepsia more common in women (2:1 ratio)
- Age distribution: Functional causes predominate in younger patients; organic causes increase with age >50 years
Etiology
Most Common Causes by Age Group
| Age Group | Most Common Cause | Frequency | Key Features |
|---|---|---|---|
| <50 years | Functional dyspepsia | 50–90% | Normal endoscopy, chronic symptoms |
| 40–60 years | Peptic ulcer disease | 15–25% | H. pylori, NSAID use |
| >60 years | Organic disease | >50% | Requires endoscopic evaluation |
High-Yield Differential Diagnosis
Gastrointestinal Causes
- Functional dyspepsia (most common overall)
- Peptic ulcer disease (gastric vs. duodenal)
- Gastroesophageal reflux disease (GERD)
- Gastroparesis
- Gastric cancer (especially >50 years)
Pancreaticobiliary Causes
- Acute pancreatitis (high-yield for boards)
- Acute cholecystitis
- Choledocholithiasis
- Chronic pancreatitis
Extra-abdominal Causes
- Myocardial infarction (especially inferior wall MI)
- Pneumonia (lower lobe)
- Diabetic ketoacidosis
Clinical Features
Pain Characteristics by Diagnosis
| Abdominal Pain Patterns – Condition-Based Comparison | ||||
| Condition | Pain Pattern | Food Relationship | Radiation | Board Buzzword |
| Gastric ulcer | Gnawing, burning | Worsens with food | Epigastrium to back | "Food-fear" |
| Duodenal ulcer | Gnawing, burning | Improves with food | Epigastrium | "Food-relief" |
| Acute pancreatitis | Severe, constant | No relationship | To back | - |
| GERD | Burning | Worse lying down | To chest/throat | Heartburn |
| Gastroparesis | Early satiety | Postprandial fullness | None | Diabetic history |
Red Flag Features
⚠️ Immediate evaluation required:
- Age ≥60 years with new-onset dyspepsia
- Unintentional weight loss (>10% body weight)
- Dysphagia or odynophagia
- Signs of GI bleeding (melena, hematemesis)
- Iron deficiency anemia
- Family history of gastric cancer
- Persistent vomiting
البطاقات التعليمية
البطاقة من 40
تتبع الإجابات يتطلب اشتراك
تتبع الإجابات يتطلب اشتراك
تتبع الإجابات يتطلب اشتراك
احصل على التجربة الكاملة
اشترك للوصول لفيديوهات الشرح التفصيلي والبطاقات التعليمية التفاعلية وأسئلة الممارسة مع تتبع التقدم.