Burning Abdominal Pain: Causes and Relief

What burning abdominal pain feels like

People describe it as a hot, raw, gnawing or acid feeling. It often sits in the epigastrium, the area between the bottom of the breastbone and the belly button. It may come with fullness, bloating, belching, nausea or a sour taste. When it rises behind the breastbone it is called heartburn.

Timing gives clues:

• Burning stomach pain after eating: gastritis, a stomach ulcer, reflux or functional dyspepsia
• Burning on an empty stomach or at night, eased by food: classic for a duodenal ulcer
• Burning when lying down or bending over: acid reflux

Causes of burning abdominal pain

Gastritis

Gastritis is inflammation of the stomach lining. It causes burning or gnawing upper belly pain, nausea and early fullness. Common causes are NSAIDs, alcohol, H. pylori infection, smoking and severe stress from illness. It can appear suddenly after a drinking binge or a few days of ibuprofen.

Peptic ulcer

A peptic ulcer is an open sore in the lining of the stomach or the first part of the small intestine (duodenum). The burning pain often comes and goes over weeks. Duodenal ulcers typically hurt 2 to 3 hours after meals and at night, and feel better after eating. Stomach ulcers may hurt more with food. The two main causes are H. pylori infection and NSAIDs, including low-dose aspirin.

Acid reflux and GERD

In gastroesophageal reflux disease (GERD), stomach acid flows back into the esophagus. The burning is mostly behind the breastbone but often starts in the upper belly. It is worse after large meals, lying flat, bending and at night, and comes with a sour taste or regurgitation.

Functional dyspepsia

When no ulcer or inflammation is found but the burning, fullness and early satiety persist, doctors call it functional dyspepsia. It is very common and related to oversensitive stomach nerves and slow stomach emptying.

Less common but important causes

• Pancreatitis: severe, constant upper belly pain that bores through to the back, with vomiting; linked to gallstones and alcohol.
• Gallbladder disease: pain is usually more aching or cramping, in the upper right belly, after fatty meals, but can feel like burning.
• Stomach cancer: rare, but suspected with burning plus weight loss, anemia, persistent vomiting or difficulty swallowing in older adults.
• Heart attack: in women, older adults and people with diabetes, a heart attack can feel like upper belly burning or indigestion.
• Shingles: a band of burning pain on one side of the belly a few days before a blistering rash appears.

Burning lower abdominal pain

Burning lower in the belly has different causes:

• Urinary tract infection: burning above the pubic bone with burning urination, urgency and frequency. See UTI.
• Irritable bowel syndrome: cramping or burning that eases after a bowel movement, with diarrhea or constipation.
• Inflammatory bowel disease, diverticulitis or pelvic infection: pain with fever, bloody stools or abnormal discharge.
• Nerve pain: a burning patch on the skin of the lower belly, for example after hernia surgery or from a trapped nerve.

Comparing the main causes

How doctors diagnose the cause

Your doctor will ask where and when the pain occurs, what eases it, which medicines you take (especially NSAIDs and aspirin), alcohol and smoking, and about red flags such as weight loss, vomiting or black stools. They will examine your belly.

Tests may include:

• H. pylori testing: a breath test or stool antigen test. Stop acid-reducing medicines for 2 weeks beforehand if your doctor asks, as they can cause false negatives.
• Blood tests: blood count for anemia, liver tests and lipase for pancreatitis.
• Upper endoscopy (EGD): a camera through the mouth into the stomach and duodenum, recommended for people over 60 with new symptoms, or anyone with red flags.
• Ultrasound: for gallstones.
• ECG: if the heart could be the cause.

Treatment and relief

Home care

• Stop NSAIDs such as ibuprofen, naproxen and aspirin if possible. Acetaminophen (paracetamol) is gentler on the stomach. Do not stop prescribed low-dose aspirin without talking to your doctor.
• Eat smaller meals and stop eating 3 hours before bed.
• Cut back on alcohol, coffee, carbonated drinks and foods that trigger your symptoms.
• Stop smoking, which slows ulcer healing.
• Raise the head of your bed by 15 to 20 cm (6 to 8 in) if symptoms are worse at night.

Medicines

• Antacids give quick, short-lived relief. Follow the label dose.
• H2 blockers (famotidine) reduce acid for up to 12 hours.
• Proton pump inhibitors (PPIs) such as omeprazole are the most effective acid reducers. Over-the-counter courses are for 14 days. See a doctor if you need them longer.
• H. pylori treatment: a combination of antibiotics and a PPI for 10 to 14 days, followed by a test to confirm the infection has cleared.

Ulcers usually heal in 4 to 8 weeks with treatment.

Frequently asked questions

What causes a burning sensation in the stomach?

Most often, stomach acid irritating an inflamed lining from gastritis, a peptic ulcer, acid reflux or functional dyspepsia. NSAIDs, alcohol, smoking and H. pylori infection are the most common triggers. Less often, pancreatitis, gallbladder disease or, rarely, stomach cancer or a heart problem is responsible.

Why does my stomach burn after eating?

Food stimulates acid production and stretches the stomach. If the lining is inflamed (gastritis), ulcerated, or the valve at the top of the stomach is weak (reflux), this causes burning. Large, fatty or spicy meals, alcohol and coffee make it worse. Smaller meals and acid reducers usually help.

When should I worry about burning stomach pain?

Seek emergency care for vomiting blood, black stools, sudden severe pain or pain with sweating and shortness of breath. See a doctor soon for burning that lasts more than 2 weeks, wakes you at night, or comes with weight loss, trouble swallowing or persistent vomiting.

Can anxiety cause burning stomach pain?

Anxiety and stress can worsen functional dyspepsia and reflux, increasing burning and nausea. Stress alone rarely causes an ulcer, though severe physical stress from serious illness can. If symptoms persist, get checked for H. pylori and other causes rather than assuming stress is to blame.

What is the fastest way to relieve a burning stomach?

An antacid works within minutes. Sitting upright, sipping water and avoiding further food, alcohol and NSAIDs also help. For frequent symptoms, an H2 blocker or a short course of a PPI works better. Get checked if you need these for more than 2 weeks.