Gastroesophageal Reflux Disease (GERD) is a chronic condition where the lower esophageal sphincter, the muscular ring between the esophagus and the stomach, does not close properly. This malfunction allows stomach acid and contents to repeatedly flow back into the esophagus, a process called reflux. The primary symptom of GERD is heartburn, a burning sensation typically felt in the chest behind the breastbone. While discomfort is usually centered in the chest, whether this disorder can manifest as pain in the side is a common concern.
The Direct Answer: GERD and Referred Pain
GERD does not typically cause localized pain in the side, but the sensation can be perceived there through visceral referred pain. Nerves transmitting pain signals from the esophagus and stomach are not specialized for location. They converge with somatic nerves at the same spinal cord segments, confusing the brain about the pain’s true origin.
The brain misinterprets the distress signal from the irritated esophagus as originating from an area innervated by the same spinal nerves, such as the upper abdomen or back. This shared neural pathway is why severe reflux pain might be felt as a burning or aching sensation in the upper side or back, often between the shoulder blades.
Understanding Different Pain Locations
To assess the source of discomfort, it is helpful to distinguish between abdominal regions. Referred pain associated with GERD is usually felt in the upper abdominal quadrants, often just under the rib cage. This location is affected due to its proximity to the stomach and shared sensory pathways with the lower esophagus.
True flank pain is distinct; it is felt on the side and back of the body, specifically between the lower ribs and the hip. If pain is genuinely located in this lower back and side area, GERD is highly improbable as the cause. Pain localized to the flank most often points to issues with organs or structures situated deeper in that region.
Alternative Causes of Pain in the Side
Since genuine flank pain is rarely attributable to GERD, other conditions are more likely sources of discomfort in the side and back.
Kidney Issues
The kidneys are a primary source of true flank pain. Conditions like kidney stones or pyelonephritis (kidney infection) are common culprits. Kidney stone pain is often sudden, severe, and colicky, sometimes radiating toward the groin. A kidney infection typically presents with flank pain accompanied by systemic symptoms like fever, chills, and painful urination.
Gallbladder Disease
Gallbladder disease, such as cholecystitis or gallstones, frequently causes pain that radiates to the side and back. This pain is typically located in the right upper quadrant of the abdomen but can extend to the back and the right shoulder blade. The discomfort is often sharp and post-meal, occurring when a gallstone blocks the flow of bile, leading to inflammation.
Pancreatitis
Pancreatitis, inflammation of the pancreas, can cause intense side and back pain radiating from the upper abdomen. This condition presents with severe, persistent abdominal pain that frequently travels straight through to the back.
Musculoskeletal Strain
A common, non-organ-related source of pain is musculoskeletal strain, such as a pulled muscle or costochondritis. Costochondritis affects the cartilage connecting the ribs to the breastbone. This type of pain is often exacerbated by specific movements or deep breaths and can be reproduced by pressing on the affected area.
When to Seek Immediate Medical Help
While most instances of side pain are not medical emergencies, certain accompanying symptoms require immediate professional evaluation. Seek emergency care if the pain is sudden, extremely severe, and unrelenting, or if it prevents you from standing or walking. Immediate medical attention is also required if the pain is accompanied by a high fever or chills, which can indicate a serious infection like pyelonephritis. Other symptoms that signal an emergency include:
- Vomiting blood.
- Passing bloody or black, tarry stools.
- Sudden pain alongside shortness of breath.
- Jaundice (yellowing of the skin or eyes).
- A rigid abdomen that is extremely tender to the touch.