Pain in Upper Stomach Between Ribs

Man with Pain in Upper Stomach Area

If you are experience pain in upper stomach between your ribs, you should understand that it might be caused by more that 10 reasons. The upper abdominal area is a part of the trunk between the lower ribs and the navel. Epigastrium is the medical term for the upper middle region which lies high up in the abdomen. It is roughly where the breastbone ends, although some of the abdominal area is tucked under the ribcage and behind the breastbone.

Causes of Pain in Upper Stomach Between Ribs

1. Esophageal (Gullet) Disorders

  • Upper central abdominal pain during swallowing may appear in esophageal varices (primarily in chronic alcoholics) or in esophageal ulcers due to prolonged stomach acid reflux
  • Strong painful cramps in the esophagus that might be felt behind and below the breastbone might be because of:
    • Dry food
    • Hard passage of the food since of the dry esophageal mucosa (in dehydration), overgrown fibrous tissue (strictures) in extended GERD or, rarely, in systemic sclerosis
    • Inappropriate relaxation of the muscles that accept the stomach entryway (cardia) due to broken nerves (primarily during surgery).

Diagnosis is made from history or by upper endoscopy (esophagoscopy).


Gastro-esophageal reflux disease (GERD) refers to back-flow of stomach acid into esophagus. Burning pain below and behind the breastbone and/or in the throat and acidic taste in mouth are primary symptoms. The cause is insufficient closure of the stomach entrance from numerous reasons, like herniation of the upper part of the stomach through an expanded opening in the diaphragm (hiatus hernia). Diagnosis is made from symptoms, upper endoscopy and measuring of pressures and pH in the esophagus.

3. Gastritis

Gastritis (Latin gaster = stomach; -itis denotes inflammation) is inflammation of the inner layer (mucosa) of the stomach with one or more of the following symptoms:

  • Burning pain in upper stomach between ribs and below breastbone, aggravating during or after the meal.
  • Nausea and vomiting.
  • Early satiety.
  • Extreme belching (burping).
  • Fever.
  • Heartburn, burning feeling behind the breastbone and/or in the throat.
  • Abdominal cramps.
  • Black stools.

The causes of severe (sudden) gastritis consist of infection with rotavirus (stomach influenza), primarily in children, gastrointestinal disorder, extreme secretion of gastric acid, strong pain meds like aspirin or ibuprofen, acidic foods, spices and so on.

The causes of chronic (extended or persistent) gastritis include infection by bacterium Helycobacter pylori, unusual autoimmune gastritis (with vit B12 deficiency and anemia), chronic poisoning and so on.

For the most parts, diagnosis of gastritis may be made from symptoms. In skeptical cases, X-ray with contrast (barium swallow) and upper endoscopy (gastroscopy) may be carried out. White blood cells in the blood might (not needed) rise and stool test for occult blood might be favorable.

4. Gastroparesis

Gastroparesis refers to slow stomach emptying due to insufficient relaxation of muscles that embrace the stomach exit (pylorus) because of broken nerves (mostly in long term atherosclerosis or diabetes), hormone disorders, mental reasons or fibrous tissue after healing of chronic gastric ulcer or after stomach surgery. Pain or cramping during or quickly after the meal in the in upper stomach between ribs, early satiety, heartburn, upper abdominal bloating and extreme belching (burping) are main symptoms. Diagnosis is made by gastric emptying tests.

5. Peptic Ulcer

Stomach ulcer is an open sore appearing in the inner layer (mucosa) of the stomach, which causes dull or burning pain in the upper middle abdominal area between ribs during or soon after the meal; avoiding eating and dropping weight may follow.
Duodenal ulcer appears in the duodenum (the first part of the small intestine) and may cause dull or burning pain between meals and usually at night. Black stool from bleeding may appear in both gastric and duodenal ulcers.

Diagnosis of a peptic ulcer is made by upper endoscopy (gastroduodenoscopy).

6. Stomach Carcinoma (Stomach Cancer)

Information verified by the team.

Stomach cancer might appear at any age but primarily in people after 50. Next to upper middle abdominal pain, nausea, bad hunger, dropping weight and black stools are common. Medical diagnosis is confirmed by gastroscopy and evaluation of the sample of the stomach mucosa under the microscope.

7. Pancreatic Disorders

  • Inflamed pancreas. Intense pancreatitis is inflammation of the pancreas, primarily due to long term alcohol abuse or gallstones and might cause central or left side upper abdominal pain and nausea. Chronic pancreatitis generally arises from duplicating attacks of intense pancreatitis.
  • Pancreatic cancer may be preceded by long term chronic pancreatitis, but it might develop from the healthy pancreas. Main symptoms are upper middle abdominal pain, bad appetite, slimming down and white diarrhea or drifting stools.

In acute pancreatitis, pancreatic enzymes in the blood are elevated. Diagnosis of chronic pancreatitis is normally made by CT; pancreatic enzymes in the blood are not usually altered. In pancreatic cancer, pancreatic amylase and CA-19-9 marker (not constantly) rise.

8. Muscle Tear

Muscle tear is generally due to injury (hit with a tough item, stitch with a sharp item or rupture during exercise). The hurt spot is tender to the touch in upper stomach between ribs and nearest areas. Hematoma (blood collection) may develop within the muscle and can cause a small visible (bluish) and palpable (soft) bulge. Medical diagnosis is made by health examination and ultrasound.

9. Intestinal Hernia

A part of small intestine might extend through a cleft in upper abdominal muscles. Pain and a soft bulge of a golf ball size are main symptoms. Doctor can typically offer medical diagnosis after physical exam.

10. Broken Breastbone

  • Damaged xiphoid (the lower part of the breastbone) may cause pain in upper stomach between ribs. Diagnosis is made by X-ray.
  • Costohondritis – inflammation of the connection in between the bony and cartilaginous parts of the lower ribs (about an inch from the breastbone on each side) might appear as chest and upper middle abdominal pain. Lower rib( s) may hurt to the touch. Medical diagnosis is made by physical examination.

11. Spine Disorders

Bulging or herniated disc, spondylitis (spine arthritis), damaged vertebra or other disorder in the chest or back part of the spinal column may cause upper middle abdominal pain and middle or lower back pain. Pain typically changes with moving or body position, intensifies with sitting and is alleviated by walking. Medical diagnosis is made by CT or MRI.

12. Aneurysm or Dissection of Abdominal Aorta

In patients over 50 years of age, the wall of the aorta may be compromised due to atherosclerosis or other disorder resulting in aortic wall bulging (aneurysm) or splitting of its layers (dissection). Constant dull upper abdominal pain between ribs that aggravates during or after the meal is the primary symptom. Diagnosis is made by the ultrasound, CT or MRI.

13. Heart Attack

Cardiac arrest might appear with upper middle or left upper abdominal pain and is rare prior to 40 years of age. Smoking and high blood cholesterol are two crucial risk factors. Diagnosis is made on the basis of symptoms, ECG and elevation of certain enzymes in the blood.

14. Lymphoma

Enlarged lymph nodes near the stomach, appearing in gastric lymphoma might be painful. Low grade fever, paleness, tiredness and reducing weight are other symptoms of lymphoma. Diagnosis is made by CT or MRI.

Reyus Mammadli

As a healthy lifestyle advisor I try to guide individuals in becoming more aware of living well and healthy through a series of proactive and preventive measures, disease prevention steps, recovery after illness or medical procedures.

Education: Bachelor Degree of Medical Equipment and Electronics.

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