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Pain in the epigastral area: current aspects of differential diagnosis

https://doi.org/10.21518/ms2024-365

Abstract

Epigastric pain can have a variety of etiologies, including not only diseases of the upper gastrointestinal tract (GIT): gastroesophageal reflux disease, hiatal hernia, gastritis and duodenitis, gastric and/or duodenal ulcers, polyps and stomach cancer, functional dyspepsia, but also other gastrointestinal diseases, somatic diseases of other organs and systems, vascular pathology, infections and invasions, medications and a number of other reasons. More than 10 years have passed since the publication of our previous article on the issues of differential diagnosis of pain in the stomach. In the Elibrary.ru information base, both in the period of time preceding the publication and to this day, we have not found similar publications. This explains its placement in full or in fragments on specialized gastroenterological sites and guidelines for differential diagnosis in gastroenterology. Over the past 10 years, new consensuses and clinical recommendations have been published on diseases and conditions associated with epigastric pain, and the number of publications on other diseases and conditions that were previously considered very rare, but which today must be taken into account when carrying out differential diagnosis, has increased. Several foreign publications on the problem in recent years were found in the PubMed electronic database. In this regard, we consider it appropriate to consider the current aspects of the differential diagnosis of epigastric pain from the perspective of today. The list of diseases and conditions presented in the review, in which epigastric pain occurs in the clinical picture, indicates that the differential diagnosis of this syndrome is an interdisciplinary problem and is of interest not only to the gastroenterologist and therapist, but also to doctors of other specialties.

About the Authors

D. I. Trukhan
Omsk State Medical University
Russian Federation

Dmitry I. Trukhan, Dr. Sci. (Med.), Professor of the Chair of Polyclinic therapy and internal diseases

12, Lenin St., Omsk, 644043



L. V. Tarasova
Chuvash State University named after I.N. Ulyanov
Russian Federation

Larisa V. Tarasova, Dr. Sci. (Med.), Head of the Department of Faculty and Hospital Therapy

9, Cheboksary, Moskovskiy Ave., 428015



References

1. Trukhan DI, Tarasova LV. Pain in the stomach area: issues of differential diagnosis. Spravochnik Poliklinicheskogo Vracha. 2013;(2):7–10. (In Russ.) Available at: https://www.elibrary.ru/shbwtr.

2. Трухан ДИ, Филимонов СН. Дифференциальный диагноз основных гастроэнтерологических синдромов и симптомов. М.: Практическая медицина; 2016. 168 с. Режим доступа: https://www.elibrary.ru/uvppkr.

3. Robinson P, Perkins JC Jr. Approach to Patients with Epigastric Pain. Emerg Med Clin North Am. 2016;34(2):191–210. https://doi.org/10.1016/j.emc.2015.12.012.

4. Vij A, Zaheer A, Kamel IR, Porter KK, Arif-Tiwari H, Bashir MR et al. ACR Appropriateness Criteria® Epigastric Pain. J Am Coll Radiol. 2021;18(11S):S330–S339. https://doi.org/10.1016/j.jacr.2021.08.006.

5. Lukic S, Mijac D, Filipovic B, Sokic-Milutinovic A, Tomasevic R, Krstic M, Milosavljevic T. Chronic Abdominal Pain: Gastroenterologist Approach. Dig Dis. 2022;40(2):181–186. https://doi.org/10.1159/000516977.

6. Lambert C, Mahévas T, Gobert D, Bravetti M, Radzik A, Poujol-Robert A et al. Epigastric pain. Rev Med Interne. 2022;43(4):260–261. https://doi.org/10.1016/j.revmed.2021.07.007.

7. Vakil N, Halling K, Ohlsson L, Wernersson B. Symptom overlap between postprandial distress and epigastric pain syndromes of the Rome III dyspepsia classification. Am J Gastroenterol. 2013;108(5):767–774. https://doi.org/10.1038/ajg.2013.89.

8. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. 2016;150(6):1262–1279.e2. https://doi.org/10.1053/j.gastro.2016.02.032.

9. Crafa P, Franceschi M, Rodriguez Castro KI, Barchi A, Russo M et al. Functional Dyspesia. Acta Biomed. 2020;91(3):e2020069. https://doi.org/10.23750/abm.v91i3.10150.

10. Kawada T. Epigastric Pain Syndrome, Functional Dyspepsia, and Sleep Disturbance. Dig Dis Sci. 2021;66(7):2466–2467. https://doi.org/10.1007/s10620-021-07036-9.

11. Vakil N. Epigastric pain in dyspepsia and reflux disease. Rev Gastroenterol Disord. 2003;3(Suppl. 4):S16–21. Available at: https://pubmed.ncbi.nlm.nih.gov/14671510/.

12. Zhang MY, Tan ND, Li YW, Sifrim D, Pandolfino JE, Xiao YL, Chen MH. Esophageal symptoms versus epigastric symptoms: Relevance for diagnosis of gastroesophageal reflux disease. J Dig Dis. 2020;21(12):696–704. https://doi.org/10.1111/1751-2980.12946.

13. Musbahi A, Mahawar K. Hiatal hernia. Br J Surg. 2023;110(4):401–402. https://doi.org/10.1093/bjs/znac449.

14. Phillips RA, Nadel ES, Brown DF. Epigastric pain. J Emerg Med. 2006;30(1):81–84. https://doi.org/10.1016/j.jemermed.2005.11.014.

15. Truhan DI, Tarasova LV. The clinical symptoms, diagnostics and treatment of chronic duodenitis. Experimental and Clinical Gastroenterology. 2012;(11):104–114. (In Russ.) Available at: https://www.elibrary.ru/selubp.

16. Dilawari JB, Blendis LM, Edwards DA. Epigastric pain in duodenal ulcer. Br Med J. 1975;2(5965):254–255. https://doi.org/10.1136/bmj.2.5965.254.

17. Kavitt RT, Lipowska AM, Anyane-Yeboa A, Gralnek IM. Diagnosis and Treatment of Peptic Ulcer Disease. Am J Med. 2019;132(4):447–456. https://doi.org/10.1016/j.amjmed.2018.12.009.

18. Tuerk E, Doss S, Polsley K. Peptic Ulcer Disease. Prim Care. 2023;50(3):351–362. https://doi.org/10.1016/j.pop.2023.03.003.

19. Gockel I, Hartmann W, Köhler H, Leonhardi J, Heyn S, Thieme R. Epigastric pain in “gastric tumors”: The hummingbird among the differential diagnoses. Chirurg. 2022;93(4):395–398. https://doi.org/10.1007/s00104-021-01522-6.

20. Hashash JG, El-Haddad A, Barada K. Acute Epigastric Abdominal Pain PostGastric Polypectomy. Gastroenterology. 2018;154(4):e12–e14. https://doi.org/10.1053/j.gastro.2017.05.061.

21. Kroupa R, Pavlik T, Konecny S, Packova B, Dastych M, Pavlovsky Z, Dolina J. The association between duration of and indications for proton pump inhibitor use and risk of gastric polyps. Eur J Gastroenterol Hepatol. 2023;35(8):829–835. https://doi.org/10.1097/MEG.0000000000002587.

22. Трухан ДИ, Тарасова ЛВ, Филимонов СН, Викторова ИА. Болезни пищевода, желудка и двенадцатиперстной кишки. Клиника, диагностика и лечение. СПб.: СпецЛит; 2014. 158 с. Режим доступа: https://www.elibrary.ru/vxanxj.

23. Farmer AD, Aziz Q. Visceral pain hypersensitivity in functional gastrointestinal disorders. Br Med Bull. 2009;91:123–136. https://doi.org/10.1093/bmb/ldp026.

24. Schmulson MJ, Drossman DA. What Is New in Rome IV. J Neurogastroenterol Motil. 2017;23(2):151–163. https://doi.org/10.5056/jnm16214.

25. Tack J, Drossman DA. What’s new in Rome IV? Neurogastroenterol Motil. 2017;29(9). https://doi.org/10.1111/nmo.13053.

26. Simanenkov VI, Maev IV, Tkacheva ON, Alekseenko SA, Andreev DN, Bordin DS et al. Syndrome of increased epithelial permeability in clinical practice. Multidisciplinary national Consensus. Cardiovascular Therapy and Prevention (Russian Federation). 2021;20(1):2758. (In Russ.) https://doi.org/10.15829/1728-8800-2021-2758.

27. Lee KJ. The Usefulness of Symptom-based Subtypes of Functional Dyspepsia for Predicting Underlying Pathophysiologic Mechanisms and Choosing Appropriate Therapeutic Agents. J Neurogastroenterol Motil. 2021;27(3):326–336. https://doi.org/10.5056/jnm21042.

28. Grassi R, Romano S, Pinto A, Romano L. Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol. 2004;50(1):30–36. https://doi.org/10.1016/j.ejrad.2003.11.012.

29. Eda H, Oshima T, Hirota S, Miwa H. Endoscopic findings in a patient with epigastric pain. Gut. 2022;71(1):9–77. https://doi.org/10.1136/gutjnl-2020-322332.

30. Al-Abachi KT. Diagnostic value of endoscopy in adult patients with dyspepsia. Prz Gastroenterol. 2022;17(4):274–279. https://doi.org/10.5114/pg.2021.112250.

31. Ivashkin VT, Mayev IV, Lapina TL, Sheptulin AA, Trukhmanov AS, Baranskaya YeK et al. Diagnostics and treatment of Helicobacter pylori infection in adults: Clinical guidelines of the Russian gastroenterological association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018;28(1):55–70 (In Russ.) https://doi.org/10.22416/1382-4376-2018-28-1-55-70.

32. Лазебник ЛБ, Бордин ДС, Дехнич НН, Козлов РС, Тряпышко АА. VII национальные рекомендации по диагностике и лечению заболеваний, ассоциированных с Helicobacter pylori (VII Московские соглашения). Проект. 2021. Режим доступа: https://www.rnmot.ru/ru/library/clinical/.

33. Testa A, Lauritano EC, Giannuzzi R, Pignataro G, Casagranda I, Gentiloni Silveri N. The role of emergency ultrasound in the diagnosis of acute non-traumatic epigastric pain. Intern Emerg Med. 2010;5(5):401–409. https://doi.org/10.1007/s11739-010-0395-4.

34. Grassi R, Romano S, Pinto A, Romano L. Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol. 2004;50(1):30–36. https://doi.org/10.1016/j.ejrad.2003.11.012.

35. Recognizing and understanding illnesses: epigastric pain as the chief symptom. Lindner UK.Pflege Z. 2008;61(4):232–235. Available at: https://pubmed.ncbi.nlm.nih.gov/18481708/.

36. Trukhan DI, Degovtsov EN, Davydov EL. Cholecystocardial syndrome in real clinical practice. Meditsinskiy Sovet. 2021;(4):212–219. (In Russ.) https://doi.org/10.21518/2079-701X-2021-4-212-219.

37. Трухан ДИ, Викторова ИА, Иванова ДС. Актуальные аспекты клиники, диагностики и лечения заболеваний желчного пузыря и желчевыводящих путей. СПб.: СпецЛит; 2023. 127 с. Режим доступа: https://elibrary.ru/cuhzdl.

38. Futagami S, Yamawaki H, Agawa S, Ikeda G, Noda H, Kirita K et al. Comparison of Functional Dyspepsia and Early Chronic Pancreatitis. J Nippon Med Sch. 2020;87(1):2–6. https://doi.org/10.1272/jnms.JNMS.2020_87-101.

39. Ashraf H, Colombo JP, Marcucci V, Rhoton J, Olowoyo O. A Clinical Overview of Acute and Chronic Pancreatitis: The Medical and Surgical Management. Cureus. 2021;13(11):e19764. https://doi.org/10.7759/cureus.19764.

40. Futagami S, Wakabayashi M. Pancreatic Dysfunction and Duodenal Inflammatory Responses Co ordinate with Refractory Epigastric Pain Including Functional Dyspepsia: A Narrative Review. J Nippon Med Sch. 2022;89(3):255–262. https://doi.org/10.1272/jnms.JNMS.2022_89-311.

41. Ferreira-Aparicio FE, Gutiérrez-Vega R, Gálvez-Molina Y, Ontiveros-Nevares P, Athie-Gútierrez C, Montalvo-Javé EE. Diverticular disease of the small bowel. Case Rep Gastroenterol. 2012;6(3):668–676. https://doi.org/10.1159/000343598.

42. Тарасова ЛВ, Трухан ДИ. Болезни кишечника. Клиника, диагностика и лечение. СПб.: СпецЛит; 2022. 223 с. Режим доступа: https://elibrary.ru/txylvk.

43. Ballou S, Singh P, Nee J, Rangan V, Iturrino J, Geeganage G et al. Prevalence and Associated Factors of Bloating: Results From the Rome Foundation Global Epidemiology Study. Gastroenterology. 2023;165(3):647–655.e4. https://doi.org/10.1053/j.gastro.2023.05.049.

44. Zvenigirodskaia LA, Kuznetsov MP, Samsonova NG, Taranchenko IuV. Chronic ischemic disease of the digestive system. Eksp Klin Gastroenterol. 2002:(2):13–17. Available at: https://pubmed.ncbi.nlm.nih.gov/12046377/.

45. Zvenigorodskaia LA, Samsonova NG. Chronic ischemic disease of the digestive system: clinical course variants, diagnostics, and treatment. Eksp Klin Gastroenterol. 2007:(2):74–79. Available at: https://pubmed.ncbi.nlm.nih.gov/17539349/.

46. van Bockel JH, Geelkerken RH, Wasser MN. Chronic splanchnic ischaemia. Best Pract Res Clin Gastroenterol. 2001;15(1):99–119. https://doi.org/10.1053/bega.2001.0158.

47. Kolkman JJ, Mensink PB, van Petersen AS, Huisman AB, Geelkerken RH. Clinical approach to chronic gastrointestinal ischaemia: from ‘intestinal angina’ to the spectrum of chronic splanchnic disease. Scand J Gastroenterol Suppl. 2004;(241):9–16. https://doi.org/10.1080/00855920410010933.

48. Schuppisser M, Khallouf J, Abbassi Z, Erne M, Vettorel D, Paroz A, Naiken SP. Abdominal Mondor disease mimicking acute appendicitis. Int J Surg Case Rep. 2016;20:37–40. https://doi.org/10.1016/j.ijscr.2015.12.031.

49. Desai V, Sajjana G, Kakadiya R, Jena A, Gupta P, Sharma V. Mondor’s disease in a patient with ulcerative colitis. J R Coll Physicians Edinb. 2023;53(1):53–54. https://doi.org/10.1177/14782715221145615.

50. Iqbal S, Chaudhary M. Median arcuate ligament syndrome (Dunbar syndrome). Cardiovasc Diagn Ther. 2021;11(5):1172–1176. https://doi.org/10.21037/cdt-20-846.

51. Vovchuk IM, Khromykh KV, Formanchuk TV, Chyhir IV. Dunbar syndrome: clinical manifestation in adults, diagnostic problems (case report). Wiad Lek. 2022;75(7):1801–1804. https://doi.org/10.36740/WLek202207135.

52. Трухан ДИ, Филимонов СН, Темникова ЕА. Болезни сердечно-­сосудистой системы: клиника, диагностика и лечение. Гериатрические аспекты в кардиологии. СПб.: СпецЛит; 2022. 365 с. Режим доступа: https://elibrary.ru/rplneq.

53. Trukhan DI, Rozhkova MYu, Ivanova DS, Trukhan LY, Goloshubina VV, Bagisheva NV. Possible causes of pain syndrome development in the right hypochondrium: in the focus of opistorchosis. Clinical Review for General Practice. 2021;2(10):20–25. (In Russ.) https://doi.org/10.47407/kr2021.2.10.00114.

54. Starostina OYu, Panushkina II. The comparative characteristic of methods of laboratory diagnostic of opisthorchiasis. Klinichescheskaya Laboratornaya Diagnostika. 2014;59(4):44–46. (In Russ.) Available at: https://elibrary.ru/sduojf.

55. Trukhan DI, Tarasova LV. Helminthiasis: current issues. Consilium Medicum. 2013;15(12):52–56. (In Russ.) Available at: https://www.elibrary.ru/rtggbf.

56. Shamsi S, Barton DP. A critical review of anisakidosis cases occurring globally. Parasitol Res. 2023;122(8):1733–1745. https://doi.org/10.1007/s00436-023-07881-9.

57. Shimamura Y, Muwanwella N, Chandran S, Kandel G, Marcon N. Common Symptoms from an Uncommon Infection: Gastrointestinal Anisakiasis. Can J Gastroenterol Hepatol. 2016;2016:5176502. https://doi.org/10.1155/2016/5176502.

58. Grinevich VB, Gubonina IV, Doshchitsin VL, Kotovskaya YuV, Kravchuk YuA, Ped VI et al. Management of patients with comorbidity during novel coronavirus (COVID-19) pandemic. National Consensus Statement 2020. Cardiovascular Therapy and Prevention (Russian Federation). 2020;19(4):2630. (In Russ.) https://doi.org/10.15829/1728-88002020-2630.

59. Elbeltagi R, Al-Beltagi M, Saeed NK, Bediwy AS. COVID-19-induced gastrointestinal autonomic dysfunction: A systematic review. World J Clin Cases. 2023;11(22):5252–5272. https://doi.org/10.12998/wjcc.v11.i22.5252.

60. Jin S, Lu X, Xu C. COVID-19 induces gastrointestinal symptoms and affects patients’ prognosis. J Int Med Res. 2022;50(10):3000605221129543. https://doi.org/10.1177/03000605221129543.

61. Marilov VV. A transition of a functional disease to an organic psychosomatic disorder. Zh Nevrol Psikhiatr Im S S Korsakova. 2006;106(1):21–23. Available at: https://pubmed.ncbi.nlm.nih.gov/16457129/.

62. Трухан ДИ, Викторова ИА. Нефрология. Эндокринология. Гематология. СПб.: СпецЛит; 2023. 352 c. Режим доступа: https://www.elibrary.ru/dqfpmu.

63. Tarasova LV, Trukhan DI. Diabetic gastroparesis: focus on the choice of a prokinetic. Practical Medicine. 2014;1(77):41–45. (In Russ.) Available at: https://www.elibrary.ru/rxqywr.

64. Fujishiro M, Kushiyama A, Yamazaki H, Kaneko S, Koketsu Y, Yamamotoya T

65. et al. Gastrointestinal symptom prevalence depends on disease duration

66. and gastrointestinal region in type 2 diabetes mellitus. World J Gastroenterol. 2017;23(36):6694–6704. https://doi.org/10.3748/wjg.v23.i36.6694.

67. Gilbert RJ, Siamwala JH, Kumar V, Thompson CC, Shikora SA. Reconsideration of the Gastroparetic Syndrome. Curr Gastroenterol Rep. 2023;25(4):75–90. https://doi.org/10.1007/s11894-023-00865-w.

68. Bekkelund M, Sangnes DA, Gunnar Hatlebakk J, Aabakken L. Pathophysiology of idiopathic gastroparesis and implications for therapy. Scand J Gastroenterol. 2019;54(1):8–17. https://doi.org/10.1080/00365521.2018.1558280.

69. Grover M, Farrugia G, Stanghellini V. Gastroparesis: a turning point in understanding and treatment. Gut. 2019;68(12):2238–2250. https://doi.org/10.1136/gutjnl-2019-318712.

70. Usai-Satta P, Bellini M, Morelli O, Geri F, Lai M, Bassotti G. Gastroparesis: New insights into an old disease. World J Gastroenterol. 2020;26(19):2333–2348. https://doi.org/10.3748/wjg.v26.i19.2333.

71. Li Z, Xu D, Wang Z, Wang Y, Zhang S, Li M, Zeng X. Gastrointestinal system involvement in systemic lupus erythematosus. Lupus. 2017;26(11):1127–1138. https://doi.org/10.1177/0961203317707825.

72. Трухан ДИ, Филимонов СН, Викторова ИА. Клиника, диагностика и принципы лечения основных ревматических болезней. СПб.: СпецЛит; 2023. 239 с. Режим доступа: https://elibrary.ru/mvzgbg.

73. Shaik MR, Shaik NA, Mikdashi J. Autoimmune Dysphagia Related to Rheumatologic Disorders: A Focused Review on Diagnosis and Treatment. Cureus. 2023;15(7):e41883. https://doi.org/10.7759/cureus.41883.

74. Huaco Aranguri AA, Orduña Carpio RA, Ortiz Castro C, Delgado Gonzales M, Haito Chávez Y. Gastric trichobezoar: case report and literature review. Rev Gastroenterol Peru. 2022;42(3):193–198. Available at: https://pubmed.ncbi.nlm.nih.gov/36746501/.

75. Daoud R, Tlili A, Fendri S, Akrout A, Trigui A, Boujelbene S. Gastric trichobezoar: An uncommon cause of epigastric pain: A case report. Clin Case Rep. 2022;10(4):e05653. https://doi.org/10.1002/ccr3.5653.


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Trukhan DI, Tarasova LV. Pain in the epigastral area: current aspects of differential diagnosis. Meditsinskiy sovet = Medical Council. 2024;(15):12–21. (In Russ.) https://doi.org/10.21518/ms2024-365

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