Upper Center, Middle Abdominal Pain Causes, Symptoms, Treatment

Upper Center, Middle Abdominal Pain Causes, Symptoms, Treatment

Upper Center, Middle Abdominal Pain are often caused by conditions that does not pose immediate threat to life. However, it is very important to exclude a few dangerous causes of pain in this region. Any pain in the central upper abdomen should therefore be taken seriously.

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Upper Center, Middle Abdominal Pain Causes, Symptoms, Treatment


Gastritis is the inflammation of the wall of the stomach. It results from irritation and mild erosion of the lining of the wall of the stomach without any ulceration. It often follows period of stress, or excessive consumption of alcohol or binge drinking.

  • If you had recently had a moderate to heavy drinking, and experiencing an upper central abdominal pain, you may be suffering with gastritis. 
  • The pain can be severe, dull, burning or sharp in character. 
  • It could start from the front of your upper stomach and spreading like a knife piercing through to the back, between both shoulder blades.
  •  It may be associated with a feeling of bloating as well as nausea. You may also develop a dislike for food, and seek to drink cold fluid.
  • Treatment is usually achieved with the use of medications like losec (omeprazole) and combined with gaviscon and pain killers like paracetamol (acetaminophen) or cocodamol.
  • Certain medications like ibuprofen or diclofenac, or aspirin, which belongs to the group of medications called non-steroidal-anti-inflammatory drugs (NSAIDS) can also precipitate gastritis, and indeed go beyond that to cause or worsen stomach ulcer and even perforation of the stomach.
  • Do you suffer from upper central abdominal pain following prolonged periods at work or smoking, or whenever you are really stressed? You may be having a form of gastritis too.
  • Burns, or hospitalization would increase stress, and all these can cause gastritis.
  • Gastritis is the early phase in the spectrum of diseases that can progress to stomach ulcer or even stomach bleed or perforation.
  • Pancreatitis may present like gastritis too, and only a blood test and or endoscopy and ultrasound may help to differentiate between the two conditions. So it would be wise to go to the accident and emergency department to get checked out, if your upper abdominal pain suspected to be gastritis is not getting better after a day or two.


Heartburn is different from indigestion. Many people and even health professionals use these terms interchangeably, but this should not be so.

  • Heartburn is due to the reflux or back flow of acid material from the stomach into the lower part of the oesophagus (gullet). This often follows a weakness in the valve or sphincter that controls the lower oesophagus.
  • It manifests as a burning sensation behind the breastbone in the chest – not abdomen.
  • The burning sensation is often worse after lying down in bed or at night and often leaves a sour taste in the back of the throat or mouth. It is a medical word that describes a range of conditions called Gastro-Oesophageal-Reflux-Disease (GORD).Heartburn has nothing to do with the heart.
  • Again, like indigestion, if you feel a pain in your central chest not going off within half an hour, do not assume it is heartburn. Endeavor to see your doctor as soon as possible.


This is commonly known as indigestion and causes pain in the central upper abdomen after having a meal. Other symptoms include:
  • Bloating in the upper abdomen
  • Burping/belching
  • Nausea
  • Vomiting
  • Feeling of fullness after eating only little
  • Feeling of fullness in the upper abdomen region
More serious symptoms include: Decreased appetite, weight loss, difficulty in swallowing, vomiting blood or having dark colored stools. Please consult your physician immediately if you are having any of the above symptoms.

Stomach Ulcer

Stomach ulcer, also called gastric ulcer, refers literally to an ulcer occurring on the wall of the stomach. This often happens due to erosion of the lining of the wall of the stomach and the formation of an ulcer crater.

  • Stomach ulcer presents as upper central abdominal pain of gradual onset.
  • It may be worsened by eating, thus the sufferer usually would not like eating; this may lead to progressive weight loss.
  • The pain may be sharp, piercing towards the back, and associated with feelings of nausea.
  • The pain may be worse at night, waking patient up at night around 11pm – 3 a.m.
  • Consumption of milk or antacid may help with the pain.
  • The pain usually comes in a stretch of continuous attack, lasting for about two to four weeks and then disappears, to come back again after a while.
You will need to see your doctor to confirm if the pain you feel is due to stomach ulcer. He will send you for an endoscopy or camera test which will help visualize the ulcer, and treatment can then be planned to cure the problem. There may also be a need to rule out a stomach cancer in someone with this type of pain too, especially if you are more than 50 years old.

Abdominal Aortic Aneurysm

This occurs as sudden onset severe upper central abdominal pain, sharp, radiating to the back. It is due to ballooning and rupture of the aorta, the large blood vessel that carries blood from the heart to the body.

  • It causes severe back pain that comes on at the same time as the central upper abdominal pain. 
  • It is commoner in those with high blood pressure, who have smoked in the past, or those known with aortic aneurysm in the past.
  • It is associated with dizziness and may feel faint or actually collapse if the aorta ruptures.
  • Diagnosis is by prompt ultrasound or CT scan in the Emergency Room.
  • Treatment could be by open surgery or endoscopic repair if only leaking or not yet ruptured. 


Angina is usually a problem from the heart. It sometimes presents as upper central abdominal pain.

  • The pain may start as a dull crushing pain, severe, spreading up to the chest and left arm.
  • Angina pain is usually brought on by exertion and tends to get better with resting
  • It may be associated with vomiting, cold sweats and slow or fast heart beats or palpitation.
  • It typically lasts for 10 to 15 minutes.

Heart Attack

Heart attack presents like angina, with severe sudden onset chest pain.

  • Sometimes, instead of the pain starting in the chest, it could come as an upper central abdominal pain.
  • The pain is usually dull to severe, crushing, spread to the chest, left shoulder or neck and may go to the jaws as well. There may be nausea and vomiting, as well as racing of the heart.
  • The person may become breathless, and cold and clammy. The pain typically lasts for up to or more than half an hour.
  • Any upper central abdominal pain that comes on suddenly, and spreads to any of the arm, neck or jaw and lasting more than 10 minutes is heart attack until proven otherwise.
  • Seek help immediately.

Helicobacter Pylori Infection

Helicobacter pylori is a bug that is commonly found in side the stomach of many many people. For some reasons, if the bug multiply so much inside you, they could start causing trouble that leads to the erosion and inflammation of the lining of the wall of your stomach.

  • This could lead to symptoms of gastritis or stomach ulcer, characterized by upper central abdominal pain
  • Bloating
  • Feeling sick (nauseated)
  • Diagnosis is usually through a stool testing or breathe test
  • Once the bug is confirmed to be present or casusing the upper abdominal pain, they could be eradicated within two weeks
  • The recommended treatment regime for this bug is the use of Omeprazole 20mg taken Twice Daily; Amoxycillin 1gram taken Twice Daily; And Clarithromycin 500mg Taken Twice Daily, all for seven days duration,
  • Another regime used for treatment of Helicobacter pylori is - Omeprazole 20mg Twice Daily, Metronidazole 400mg Twice daily And Clarithromycin 500mg Twice Daily, for those allergic to penicillins.


Over 7 out of 10 of us experience indigestion at one point or the other in our life. For some, it occurs every day. This is experienced as a discomfort rather than pain in the upper central abdomen, lasting for a few minutes.

  • There may be associated feeling of bloating, nausea and burping. It often follows ingestion of a heavy meal or very rich food. You may find your self belching following an attack of indigestion.
  • Indigestion is a word used to describe a constellation of the above symptoms. It is due to wind or indigestible material distending the STOMACH, and wind escaping up via the oesophagus or even downwards by causing flatulence.
Should indigestion cause severe abdominal pain or chest pain lasting more than half an hour, it is strongly advised you seek urgent medical attention, because other potentially sinister problems can present like indigestion, including heart attack, and others mentioned below.

Acute Pancreatitis

This is a condition where there is inflammation of the pancreas. This occurs commonly due to gallstones or excessive alcohol intake. The function of the pancreas is to produce enzymes which help with digestion. It also produces insulin. Pain from pancreatitis is felt as:
  • Severe and continuous pain in the central upper abdomen which worsens over the next few hours.
  • Pain radiates to the center of the back.
  • Lying on the side with flexed knee or leaning forward alleviates the pain.
  • Pain gets aggravated upon lying flat.
  • Retching.
  • Vomiting.
  • Fever may be present.
  • Yellow discoloration of the sclera.
If you are having any of the above symptoms, then seek immediate medical attention, as pancreatitis is a dangerous condition and requires immediate treatment; which comprises of I.V. fluids, pain killers and antibiotics if needed. Surgery may also be required; however, it is rare

Duodenal Ulcer

Duodenal ulcer would cause pain in the upper central abdomen too, that spreads to the back.

  • The signs and symptoms would be the same, except that eating food tends to help relieve the pain in duodenal ulcer, and thus the sufferer may find that he or she end up adding on weight.
  • Treatment is with Omeprazole or lanzoprazole and the inclusion of Rannitidine if deemed necessary to expedite the healing of the ulcer.

Gastric Carcinoma (Stomach Cancer)

Stomach cancer may appear at any age but mostly in people after 50. Beside upper middle abdominal pain, nausea, poor appetite, losing weight and black stools are common. Diagnosis is confirmed by gastroscopy and examination of the sample of the gastric mucosa under the microscope.


Gallstones are stones formed from bile produced in the liver and stored in the gall bladder.

These stones could block the gallbladder, leading to gallbladder diseases. Biliary Colic and Cholecystitis are two common conditions caused by gallstones that could cause upper central abdominal pain.

Hiatus Hernia

This occurs can also cause upper central abdominal pain. The pain may come on suddenly, and very biting. It may be associated with vomiting, and the filling of something stuck up in the upper abdomen. The pain may be worsened by eating, and relieved by vomiting.

Broken Breastbone

Broken xiphoid (the lower part of the breastbone) may cause upper middle abdominal pain. Diagnosis is made by X-ray.

Costohondritis - inflammation of the connection between the bony and cartilaginous parts of the lower ribs (about an inch from the breastbone on each side) may appear as chest and upper middle abdominal pain. Lower rib(s) may be tender to the touch. Diagnosis is made by physical examination.

Spinal Disorders

Bulging or herniated disc, spondylitis (spinal arthritis), broken vertebra or other disorder in the chest or lumbar part of the spine may cause upper middle abdominal pain and middle or lower back pain. Pain usually changes with moving or body position, aggravates with sitting and is relieved by walking. Diagnosis is made by CT or MRI.

Here are the common causes of upper central abdominal pain. Others include epigastric hernia, hepatitis, Benign Recurrent Intrahepatic Cholestasis (BRIC), herpes zoster (shingles) affecting the skin over the upper central abdomen and pseudo pancreatic cysts.

Appendicitis, in its very early phase may start at the epigastrium, but quickly moves downwards.