Pain is a euphemism for the distress that brings the mellowness and maturity level of an individual to a standstill. Epigastric pain is one of those medical auguries which can be elicited by several disorders.
Myocardial infarction (MI) is a pathologically irreversible death of myocardial cells caused by Ischemia that can induce epigastric pain. Due to high-quality measures of Cardio-protection and the emergence of novel cardioprotective strategies in an experimental arena like that of Stem Cell therapy, Ischemic postconditioning, Remote Ischemic Preconditioning (RIPC), Activation of RISK pathway & Mitochondrial Permeability Transition Pore (mPTP), this malady has been curtailed to a great extent in Europe and USA.
In the amphitheater of Gastro-enterology, Alcohol consumption, GERD, PUD, H-pylori induced Gastritis, Hepatitis, Acute, and Chronic Pancreatitis, Pancreatic calculi, Pancreatic Tuberculosis, Cholelithiasis, Cholecystitis, Abdominal Angina & SMA Syndrome are some of the aberrant conditions that can present with epigastric pain. Abdominal angina is defined as the postprandial pain that occurs in individuals who have Mesenteric Vascular Occlusive Disease that has advanced to the point where blood flow cannot increase enough to meet visceral demands. While Superior Mesenteric Artery (SMA) Syndrome is a digestive condition that occurs when the duodenum is compressed between Abdominal Aorta posteriorly and Superior Mesenteric Artery anteriorly.
In the surgical sphere, Duodenal perforation and Hiatus Hernia are the scenarios that also mimic pain epigastrium. The classical presentation of duodenal perforation is painful and tender epigastrium along with a linear radiolucent shadow of air under the diaphragm on the right side of the Abdominal X-Ray.
In the field of Oncology, Carcinoma of the Pancreas and Gastric Adenocarcinoma are the two foremost neoplasms that induce Epigastric pain. The risk factors for Pancreatic cancer include age, tobacco use, heavy alcohol use, obesity, chronic pancreatitis, DM, prior abdominal radiation, family history, CKDN2A or PRSS1 mutation, Peutz-Jeghers Syndrome, and exposure to Arsenic and Cadmium. Diarrhea, weight loss, depression, nausea, vomiting, ↓ oral intake, jaundice due to biliary obstruction, Courvoisier sign & Sister Mary Joseph’s nodule are other presenting signs and symptoms of pancreatic carcinoma.
Contrast-Enhanced Endoscopic Ultrasound (EUS) and Multiphase thin-cut helical CT are the imaging techniques of choice for the detection of Pancreatic carcinoma. Whipple resection is strictly indicated for cancers that are limited to the head of the pancreas, peri-ampullary area & Duodenum (T1, NO, MO). Metastatic Pancreatic cancers are treated with FOLFIRINOX in combination with Gemcitabine & nab-paclitaxel.8 Celiac plexus nerve block under CT Endoscopic Ultrasound guidance or Thoracoscopic splanchnicectomy may improve pain control. Metformin may improve survival in DM patients with Pancreatic Adenocarcinoma.
During my clinical practice in the second decade of the 21st century, I observed and handled numerous patients with epigastric pain. It is therefore concluded that the community of medical practitioners should shape a broad spectrum portrait of a patient with pain epigastrium which is the hallmark of my essay. A patient with pain epigastrium may suffer from a simple ailment but it is also possible that he/she may be experiencing an agonizing pathology like that of Metastatic Adenocarcinoma or Duodenal Perforation etc. In short, clinicians should not procrastinate the matter of treating chronic pain epigastrium.
The writer is a medical officer at Type D Hospital, Tehsil Banda Daud Shah, District Karak, Pakistan.
