Stomach Pain
Discomfort or pain in the abdominal region with various possible causes.
TL;DR
Stomach pain covers everything from trapped wind to a perforated ulcer. Location, tempo and associated features do the diagnostic work — and severe, sudden or persistent pain needs assessment before any supplement is considered.
Overview
Abdominal pain is one of the broadest symptoms in medicine, and the way it is described narrows the field faster than any test. Location matters: right upper quadrant pain after fatty meals suggests gallbladder; epigastric burning relieved by food suggests duodenal ulcer; right iliac fossa pain migrating from the umbilicus suggests appendicitis; left lower quadrant pain with fever suggests diverticulitis. Tempo matters equally. Pain that reaches maximum intensity within seconds suggests perforation, rupture or vascular catastrophe. Colicky pain that comes in waves suggests obstruction of a hollow organ. Constant, gradually building pain suggests inflammation. The most common causes in primary care are far more mundane — functional dyspepsia, irritable bowel syndrome, constipation, gastro-oesophageal reflux and gastroenteritis — and these account for the majority of presentations in people under 50 without alarm features. Alarm features change the calculus entirely: unintentional weight loss, difficulty swallowing, vomiting blood, black tarry stool, a palpable mass, anaemia, or new symptoms after age 50 all warrant investigation rather than symptomatic treatment. Where supplements have any evidence it is narrow: peppermint oil in enteric-coated capsules has reasonable trial support for IBS pain, and specific probiotic strains have modest support for IBS symptom scores. Neither is appropriate for undiagnosed pain, and neither treats structural disease.
Common Symptoms
- •Burning or gnawing pain in the upper abdomen
- •Cramping pain that comes in waves
- •Pain worsened or relieved by eating
- •Bloating and distension
- •Nausea or vomiting with the pain
- •Change in bowel habit
- •Pain that radiates to the back or shoulder
Common Causes
- •Functional dyspepsia and irritable bowel syndrome
- •Constipation
- •Gastro-oesophageal reflux and peptic ulcer disease
- •Gallstones and biliary colic
- •Gastroenteritis
- •Diverticulitis
- •Appendicitis
- •Kidney stones
- •Coeliac disease or lactose intolerance
- •Endometriosis in pelvic-predominant pain
Root Causes
Visceral pain from distension, ischaemia or inflammation of hollow and solid organs; parietal pain from peritoneal irritation; referred pain along shared dermatomes; and in functional disorders, visceral hypersensitivity with altered gut-brain signalling rather than structural damage.
How It's Diagnosed
Diagnostic Markers
- Full blood count and CRP
- Liver function tests and lipase or amylase
- Coeliac serology
- Faecal calprotectin to separate inflammatory from functional disease
- Helicobacter pylori testing
- Urinalysis and pregnancy test where relevant
- Abdominal ultrasound for biliary and renal causes
- Endoscopy or CT where alarm features are present
When to See a Doctor
Call emergency services for abdominal pain that is sudden and severe, comes with a rigid board-like abdomen, vomiting blood, black tarry stool, collapse, or pain with a pulsating abdominal mass. Arrange urgent assessment for pain with fever, jaundice, unintentional weight loss, persistent vomiting, or any new persistent abdominal pain starting after age 50.
Supplements Studied For This
Peppermint Oil
Enteric-coated peppermint oil has the best trial evidence of any supplement for functional abdominal pain, but only once IBS is the confirmed diagnosis.
Probiotics
Some specific strains modestly reduce functional abdominal pain, but benefits do not generalise across products and effect sizes are small.
Diet & Lifestyle
Suggested Pattern
A low-FODMAP diet delivered by a dietitian has the strongest trial evidence for functional abdominal pain in IBS, used as a structured elimination and reintroduction rather than a permanent restriction. Adequate fibre and fluid resolve a large share of constipation-related pain. Alcohol and large late meals aggravate reflux-related pain.
Eat more
- Soluble fibre sources such as oats and psyllium
- Low-FODMAP staples during a supervised elimination phase
- Smaller, more frequent meals in reflux-dominant pain
- Adequate fluids, particularly with fibre increases
Avoid
- Large late-evening meals in reflux-related pain
- Excess alcohol
- High-fat meals in biliary colic
- Sorbitol and other sugar alcohols in bloating-predominant pain
Supporting Research
Systematic review and meta-analysis: efficacy of peppermint oil in irritable bowel syndrome
The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data
Nutritional Interventions in Adult Patients With Irritable Bowel Syndrome: An Umbrella Review of Systematic Reviews and Meta-analyses of Randomized Clinical Trials
The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome
Curcumin and proton pump inhibitors for functional dyspepsia: a randomised, double blind controlled trial
Frequently Asked Questions
Who It Affects
Abdominal pain accounts for around 5-10% of emergency department visits, and functional gastrointestinal disorders affect roughly 40% of people worldwide at some point.
Quick Facts
- •Pain reaching maximum intensity within seconds suggests a vascular or perforation event
- •Most abdominal pain under 50 without alarm features is functional
- •Faecal calprotectin usefully separates inflammatory bowel disease from IBS
- •Alarm features, not pain severity, drive the decision to investigate
- •Enteric-coated peppermint oil has the best supplement evidence, and only for diagnosed IBS
Lifestyle Tips
- •Record where the pain is, how fast it peaks, and what changes it — this is more useful than a severity score
- •Get alarm features assessed before trying elimination diets
- •Treat constipation properly before assuming a more complex diagnosis
- •Ask for coeliac serology before removing gluten, not after
- •Use a structured low-FODMAP protocol with a dietitian rather than open-ended restriction
My Notes
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This information is for educational purposes only. Always consult a healthcare professional before starting any supplement regimen.