Gastroesophageal reflux disease (GERD) is a chronic condition involving the backflow of stomach contents into the esophagus. This reflux occurs when the lower esophageal sphincter weakens or relaxes inappropriately, allowing stomach acid to move upward. The Right Upper Quadrant (RUQ) refers to the upper right section of the abdomen, situated beneath the ribs. While RUQ pain is usually associated with organs located there, GERD can sometimes cause this pain through atypical presentations involving complex pain signaling pathways.
Typical Symptoms of GERD
The most common manifestation of GERD is heartburn, which presents as a burning sensation in the chest that often rises toward the throat. This discomfort typically worsens after eating, particularly large or fatty meals, or when lying down or bending over. Regurgitation is another hallmark symptom, involving the backflow of sour liquid or food particles into the mouth or throat. Some individuals also experience non-cardiac chest pain, which can be intense enough to mimic symptoms of a heart attack. Difficulty swallowing (dysphagia) or a sensation of a lump caught in the throat (globus sensation) are also characteristic symptoms.
Common Sources of Right Upper Quadrant Pain
Pain localized to the right upper quadrant rarely has GERD as its primary cause because this area houses several major organs. The liver and the gallbladder are situated here, and conditions like inflammation of the gallbladder (cholecystitis) or gallstones are frequent sources of RUQ pain. This pain often intensifies after consuming fatty foods as the gallbladder contracts to release bile. The duodenum, the first segment of the small intestine, and a portion of the pancreas are also located in or near the RUQ. Peptic ulcers in the duodenum can lead to burning pain felt in the upper abdomen, often occurring a few hours after eating.
The Mechanism of Atypical GERD Pain
GERD can sometimes cause pain in the right upper quadrant, although this is considered an atypical symptom. This phenomenon is explained by referred pain, where the brain misinterprets sensory signals originating from the esophagus. Nerves serving the esophagus share pathways with nerves serving other parts of the upper abdomen, meaning severe esophageal irritation can be perceived as radiating rightward from the midline. The standard location for GERD-related abdominal pain is the epigastric region. However, severe, chronic reflux can cause inflammation or ulcers in the lower stomach or the duodenum. Since the duodenum is partially situated within the RUQ, irritation or an active ulcer can manifest as a burning or aching sensation specifically on the right side.
When to Seek Urgent Medical Care
While GERD can cause discomfort, certain symptoms associated with RUQ pain require immediate medical attention. The sudden onset of severe, excruciating pain that causes a person to double over should prompt an emergency room visit. Pain that radiates to the back or to the right shoulder blade is a classic sign of acute gallbladder issues or sometimes pancreatitis. Other warning signs include a persistent high fever, which suggests an infection like cholecystitis or a kidney infection. The appearance of jaundice, a yellowing of the skin or eyes, indicates a problem with the liver or a blockage in the bile ducts. Any signs of internal bleeding, such as vomiting material that looks like coffee grounds or passing black, tarry stools, are also serious medical emergencies.