A burning sensation in the upper abdomen is a common complaint. This feeling, which can range from a dull ache to intense heat, is medically described as a symptom of dyspepsia (indigestion) when in the upper belly, or pyrosis when felt higher in the chest. The location of the discomfort offers clues, though the causes are varied, ranging from simple lifestyle factors to more serious underlying gastrointestinal conditions.
Acid Reflux and Heartburn
The sensation of heartburn occurs when highly acidic stomach contents flow backward into the esophagus, the tube connecting the mouth to the stomach. This backflow is known as acid reflux, and frequent occurrences may be diagnosed as Gastroesophageal Reflux Disease (GERD). Because the esophagus lacks the thick protective lining of the stomach, it is vulnerable to irritation from corrosive digestive acids.
A ring of muscle called the Lower Esophageal Sphincter (LES) acts as a valve between the esophagus and the stomach. The LES is designed to open briefly to let food pass through and then close tightly to prevent acid from moving upward. The burning sensation arises when the LES relaxes or does not close completely, allowing stomach acid to splash back and irritate the sensitive esophageal tissue.
The location of this burn is typically felt behind the breastbone, sometimes radiating up toward the throat. This occurs because the acid travels up the food pipe, irritating the sensitive tissue.
Gastritis and Peptic Ulcers
A burning sensation felt directly in the stomach or upper abdomen may indicate internal damage to the gastric lining. Gastritis is the inflammation of the stomach lining, which creates a burning or gnawing discomfort. Chronic inflammation compromises the protective barrier that shields the stomach from its own strong digestive acids.
Peptic ulcers are more severe, defined as open sores that develop on the inner lining of the stomach (gastric ulcers) or the upper part of the small intestine (duodenal ulcers). The most common causes of both gastritis and peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and the long-term use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). H. pylori infects the mucosal layer, leading to inflammation and eventual breakdown of the protective lining.
NSAIDs like ibuprofen and naproxen sodium cause damage by inhibiting the production of prostaglandins, compounds that help maintain the stomach’s protective mucus layer. When this protective barrier is weakened, the acidic environment contacts the underlying tissue, causing the painful, persistent burning sensation characteristic of an ulcer. This pain is often described as gnawing and may be temporarily relieved by eating or taking antacids.
Dietary Triggers and Medication Side Effects
Beyond chronic conditions, many external factors can cause temporary or recurring stomach burning by increasing acid production or relaxing the LES. Consuming high-fat foods slows stomach emptying, increasing the opportunity for acid reflux to occur. Acidic foods, such as citrus fruits, tomatoes, and vinegars, can directly irritate a sensitive esophageal or stomach lining.
Caffeine, alcohol, and carbonated beverages contribute to the problem by prompting the LES to relax, allowing acid to flow upward. Stress and anxiety can also lead to an increase in stomach acid secretion, exacerbating existing symptoms. Eating large meals close to bedtime increases the risk of nighttime reflux.
Certain common over-the-counter and prescription medications are known to irritate the gastrointestinal tract. Pain relievers, including aspirin, can cause irritation and inflammation of the stomach lining. Other drug classes, such as some antibiotics, iron supplements, and certain blood pressure medications, can trigger burning sensations by directly irritating the esophageal lining or promoting LES relaxation.
Warning Signs Requiring Medical Attention
While occasional stomach burning is common, certain symptoms indicate a potentially serious underlying health issue requiring immediate medical evaluation. Difficulty swallowing (dysphagia) suggests a blockage or severe inflammation in the esophagus. Unexplained weight loss is also a concern, as it can be associated with advanced disease states.
Evidence of gastrointestinal bleeding requires attention. This can manifest as blood in vomit or stools, or as black, tarry stools (melena), which indicates digested blood from the upper gastrointestinal tract. Persistent vomiting, especially if it contains blood, is another symptom. If the burning pain is severe, comes on suddenly, or radiates to the back or jaw, professional medical help should be sought immediately.