We all get bellyaches, but stomach pain comes in many different forms. It can be occasional or daily, a minor discomfort or a major disrupter. The pain can be dull or sharp and be accompanied, or not, by a long list of other symptoms.

Most causes of stomach pain, defined as discomfort in the upper abdomen, are not serious. But it’s important to pay attention to the pain so you can figure out what’s going on, how to get relief and, if possible, prevent it in the future.

Here are a few of the most common causes and what you need to know about them.

When stomach pain is an occasional problem, it might be …

  • Indigestion. Indigestion, or what your doctor might call dyspepsia, is the familiar discomfort most people have had after a holiday feast or other large meal. Some people get indigestion more often. When it happens, your stomach may feel uncomfortably full and you may feel some heat, burning, or pain. You also might feel gassy, bloated, or nauseated.

While indigestion alone isn’t a sign of serious illness, if it lasts for more than two weeks or you also have bleeding, weight loss, or trouble swallowing, you should get checked out by a doctor.

While indigestion has different causes in different people, there are things you can try to prevent future trouble. They include limiting alcohol, caffeine, and carbonated drinks and eating smaller meals at a slower pace. It’s also a good idea to avoid eating too close to bedtime. Taking a walk after dinner might also help you digest your food more comfortably.

  • Heartburn. While some people with indigestion also have heartburn, they aren’t the same thing. Heartburn refers specifically to a burning feeling in your chest or throat resulting from stomach acid backing up into your esophagus, the tube that runs from your stomach to your throat. It can be worse when you are lying down or bending over, and it often occurs right after eating.

Some of the habits that prevent indigestion also can help prevent occasional heartburn. They include eating smaller meals and avoiding eating at night. Many people also find it helpful to avoid certain foods, including fried foods, coffee, and chocolate. When heartburn is an occasional problem, most people can get relief with over-the-counter remedies that reduce stomach acid. But when it becomes chronic, you may need to talk to your physician.

  • Stomach viruses or food poisoning. If you have stomach discomfort along with vomiting or diarrhea, and maybe a fever, a virus may be to blame. While some people call such illnesses “stomach flu,” doctors refer to them as viral gastroenteritis. You can pick up stomach bugs from close contact with an infected person or from contaminated food or water. Some stomach viruses, such as norovirus and rotavirus, are especially common among young children and people in close contact with them. Such viruses sometimes cause outbreaks in group settings, such as hospitals, cruise ships, and nursing homes.

Another possible cause of such symptoms is food poisoning from bacteria. Symptoms usually start just a few hours after you eat the tainted food.

Most healthy people recover within a couple of days from either kind of infection. The best treatment is plenty of fluids. Look for beverages containing electrolytes. But if you have trouble staying hydrated, have bloody stools or fevers above 102ºF, you should seek medical advice.

When stomach pain is a frequent or constant problem, it might be …

  • Gastroesophageal reflux disease (GERD). If you have frequent heartburn that interferes with your life, you might have GERD. That means acid and other contents from your stomach back up into your esophagus. In addition to heartburn, you stomach back up into your esophagus. In addition to heartburn, you might have symptoms such as persistent sore throat, hoarseness, and cough.

If you haven’t gotten relief from over-the-counter remedies, your doctor can suggest other treatments. If you still don’t get relief, you might need a more extensive workup from a gastroenterologist, especially if your doctor suspects complications, such as damage to your esophagus. Your workup might include an upper endoscopy, a test in which a viewing tube is passed through your mouth to your esophagus and stomach. Worrisome signs include trouble swallowing and weight loss.

  • Ulcers. If you have frequent burning pains in your stomach, it could be a peptic ulcer, a sore in the lining of your stomach or the topmost part of your small intestine. Some ulcers hurt when you eat; others actually feel better after a meal. Some ulcers cause no pain at all. The first sign may be blood in your stool or other signs of blood loss, such as excess fatigue and shortness of breath. Any of those symptoms should prompt a medical workup.

Contrary to long-held beliefs, ulcers aren’t caused by spicy foods or stress. In the United States, the most common causes are medications that can damage the stomach lining, especially nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Blood-thinning drugs, taken by many older adults, increase the risk that NSAIDs will cause ulcers. The second-leading cause is infection with Helicobacter pylori (H. pylori) bacteria.

If your ulcer is caused by bacteria, it can usually be cured with antibiotics and acid-blocking drugs. If your ulcer is medication related, you will need to change your medication habits and use acid-blocking drugs.

  • Gallbladder problems. What seems like stomach pain might be coming from your gallbladder, a pear-size sac in the upper right side of your abdomen. The gallbladder stores bile, used in digestion. Substances in bile sometimes form stones, which can lead to abdominal pain. The pain can come in attacks that last a few minutes or a few hours. Some people vomit and sweat during gallstone attacks. Some gallstones cause no symptoms at all, so you might find out about them only if they show up on unrelated medical imaging tests. Gallstones can be surgically removed or, in some cases, dissolved with medication.
  • Less common causes. A few less common causes of pain in the upper abdomen include inflammation of the pancreas, celiac disease (an immune system reaction to gluten in food), and, rarely, cancer. Early stomach cancer often has no symptoms. When it does have symptoms, they can include common problems such as indigestion, mild nausea, and bloating. If you also have blood in the stool, unexplained weight loss, or trouble swallowing, see a doctor.

Could Your Stomach Pain Be a Heart Attack?

Not all heart attacks announce themselves with crushing chest pain. Some people, especially women, experience symptoms that might mimic stomach trouble, including nausea and pain that seems to be coming from the top of the stomach or lower rib cage. Some people vomit, according to the American Heart Association.

Clues that such symptoms might signal heart trouble might include shortness of breath and heart palpitations. Other heart-attack signs can include uncomfortable pressure, squeezing, or fullness in the middle of the chest, or pain in one or both arms, the back, the neck, or the jaw.

If you think you might be having a heart attack, call 911 and get to a hospital right away.

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