Understanding Upper Abdominal Discomfort: Causes and Management
Intro
Upper abdominal discomfort can arise from a variety of conditions, both benign and serious. It frequently presents a challenge for healthcare providers in terms of diagnosis and management. Understanding this symptom is crucial for both practitioners and patients alike. It is a multifaceted issue that often necessitates a thorough investigation into its causes.
This article aims to dissect upper abdominal discomfort in a comprehensive manner. We will explore potential causes, diagnostic approaches, and management strategies that enhance patient outcomes. By understanding this complex symptom, healthcare professionals can improve their clinical practices, and patients can become informed about their health.
Recent Advances
Latest Discoveries
Recent studies have broadened our understanding of the mechanisms behind upper abdominal discomfort. Research indicates that conditions such as gastroesophageal reflux disease (GERD) and peptic ulcers have variable presentations that may overlap with other gastrointestinal disorders. These findings highlight the importance of precise diagnosis based on individual patient history and symptomatology.
Furthermore, certain studies have suggested links between upper abdominal discomfort and psychosomatic disorders. Stress and anxiety can exacerbate or even contribute to gastrointestinal symptoms. This intersection between mental health and physical health prompts a more holistic approach in diagnosis and management.
Technological Innovations
Advancements in diagnostic technologies have revolutionized the evaluation of upper abdominal discomfort. High-resolution imaging techniques, such as magnetic resonance imaging (MRI) and endoscopic ultrasounds, offer clearer insights into structural anomalies of organs like the liver and pancreas.
Laboratory tests have also evolved. Biomarkers for specific conditions are now more readily available, allowing for targeted treatments. Additionally, artificial intelligence in symptom assessment helps streamline the diagnostic process, providing healthcare professionals with valuable decision-making tools.
Methodology
Research Design
This article is based on a comprehensive review of the existing literature regarding upper abdominal discomfort. It contrasts various studies that focus on symptom-specific evaluations, diagnostic advancements, and management techniques.
Data Collection Techniques
Data collection primarily involved analyzing peer-reviewed journals, clinical guidelines, and meta-analyses. Reliable online resources, such as Wikipedia and Britannica, provided supplementary insights into common causes and management strategies.
Incorporating extensive research ensures that the content is up-to-date and reflects current clinical practices.
Prologue to Upper Abdominal Discomfort
Understanding upper abdominal discomfort is essential for both patients and healthcare providers. This symptom often indicates a wide range of potential health issues, from benign to severe. Identifying the causes of upper abdominal discomfort can lead to timely diagnosis and treatment, minimizing complications.
When patients experience discomfort in the upper abdomen, it may affect their daily lives. Recognizing its importance allows for better communication between patients and health professionals. This relationship can improve patient outcomes significantly.
Additionally, educating individuals about the underlying causes can promote proactive health-seeking behavior. Knowing when to seek medical attention can prevent serious complications and ensure better management of any underlying conditions.
Defining Upper Abdominal Discomfort
Upper abdominal discomfort refers to any pain or discomfort located in the upper region of the abdomen, which encompasses the area just below the rib cage and above the navel. This discomfort can manifest as a dull ache, sharp pain, or a feeling of fullness. The nature of this discomfort can vary greatly among individuals, making it difficult to pinpoint specific causes without a thorough evaluation. Different patients may experience symptoms such as bloating, nausea, and changes in appetite, all contributing to the complexity of diagnosis and treatment.
Prevalence and Impact
The prevalence of upper abdominal discomfort is significant across various demographics. Many people experience it at some point in their lives. Research indicates that gastrointestinal disorders, which often cause this discomfort, affect a large percentage of the population.
The impact of upper abdominal discomfort should not be underestimated. For some, it can be a transient annoyance, while for others, it can indicate serious health problems that require immediate attention. This variability often complicates clinical presentations, leading to potential misdiagnosis or delayed treatment. Understanding the prevalence can help health professionals in prioritizing research and treatment initiatives.
Anatomy of the Upper Abdomen
Understanding the anatomy of the upper abdomen is essential in comprehending the potential causes of upper abdominal discomfort. This area houses many critical organs and systems. When patients report discomfort, a knowledge of the underlying anatomy helps healthcare professionals narrow down possible diagnoses. Analyzing the structures in this region allows for targeted and effective management strategies, ultimately enhancing patient care.
Key Organs and Systems
The upper abdomen is primarily defined by its key organs, which include the stomach, liver, gallbladder, pancreas, and spleen. These organs contribute to vital functions such as digestion, metabolism, and immune response.
- Stomach: Involved in food breakdown and absorption, it is often the site of conditions like gastritis and ulcers.
- Liver: Essential for detoxification and protein synthesis, liver diseases can present with upper abdominal pain, signaling issues like hepatitis or fatty liver disease.
- Gallbladder: This small organ stores bile. Issues like cholecystitis and gallstones lead to notable discomfort in this region.
- Pancreas: Responsible for hormone production and digestive enzyme secretion, it is susceptible to inflammation and cancer, both of which manifest as abdominal pain.
- Spleen: Though primarily involved with blood filtration and immune response, it can cause pain if enlarged or infected.
These organs do not function independently; rather, they are influenced by one another and work in concert, making it crucial to assess all when diagnosing abdominal discomfort.
Nerve Supply and Pain Perception
The nerve supply to the upper abdomen plays a significant role in pain perception. The abdominal cavity is innervated by the autonomic nervous system, which includes both sympathetic and parasympathetic fibers. This complex innervation allows various stimuli to be transmitted to the central nervous system, where they are interpreted as pain.
- Visceral Nerves: These are responsible for the sensations of pain arising from the internal organs. They are less precise, meaning discomfort may be perceived in a different location from where it originates.
- Somatic Nerves: These supply the skin and muscles and convey sharp, localized pain. Damage or irritation in the upper abdomen often triggers these nerves, producing a clear pain sensation.
Understanding the relationship between nerve supply and pain helps in distinguishing between visceral and somatic origins of discomfort. Accurate pain assessment aids in tailored diagnostic and therapeutic approaches.
In upper abdominal discomfort, discerning between gastrodintestinal conditions and potential cardiovascular or pulmonary issues is essential for effective management.
Common Causes of Upper Abdominal Discomfort
Understanding the common causes of upper abdominal discomfort is crucial for diagnostics and effective management. This section aims to identify various health conditions that contribute to discomfort in the upper abdomen. An awareness of these causes can help in recognizing symptoms early and guiding treatment decisions.
Gastrointestinal Conditions
Peptic Ulcer Disease
Peptic ulcer disease is a prevalent gastrointestinal issue. It arises when open sores develop on the inner lining of the stomach or the upper part of the small intestine. A significant characteristic of peptic ulcers is the burning pain in the upper abdomen. This specific aspect makes it important to highlight. The pain may worsen on an empty stomach and can often be relieved by eating. Its common occurrence among patients seeking medical attention showcases its relevance in this context.
The potential for complications, such as bleeding or perforation, adds seriousness to the issue. Early diagnosis, thus, is beneficial.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease, known as GERD, is another condition frequently associated with upper abdominal discomfort. This condition occurs when stomach acid frequently flows back into the tube connecting the mouth and stomach. A key feature of GERD is the sensation of acid backing up into the throat or mouth, often accompanied by heartburn. This makes it a significant topic in this article, given its high prevalence and the discomfort it can cause. The chronic nature of GERD can lead to complications such as esophagitis. Patients with GERD might benefit from management strategies targeting lifestyle changes and dietary adjustments.
Gastritis
Gastritis refers to the inflammation of the stomach lining. It can be acute or chronic, making it important to understand its implications. A central characteristic of gastritis is the occurrence of stomach aches or bloating. This symptom contributes to its prominence in discussions about upper abdominal discomfort. Many individuals with gastritis may experience an exacerbation of symptoms after eating certain foods. The unique feature of gastritis lies in its various potential causes, such as infections or long-term use of anti-inflammatory medications. Understanding these causes allows for targeted treatment and increased awareness of dietary choices.
Biliary Disorders
Cholecystitis
Cholecystitis involves inflammation of the gallbladder. The hallmark symptom is intense pain in the upper abdomen, often accompanied by nausea or vomiting. Its acute nature often leads to urgent care visits, making it a relevant condition to discuss. The significant feature of cholecystitis is the possibility of complications such as gallbladder rupture or abscess formation. Early recognition and management are crucial to preventing these complications.
Biliary Colic
Biliary colic is characterized by severe pain that occurs when a gallstone temporarily obstructs the bile duct. This condition can lead to episodes of discomfort that are often sudden and intense. The importance of biliary colic in this context arises from its direct connection to gallbladder disease. Recognizing the signs of biliary colic can aid prompt treatment. Understanding this disorder provides patients with insight into managing pain associated with gallstones, which is clinically relevant.
Pancreatic Conditions
Pancreatitis
Pancreatitis is the inflammation of the pancreas. An important aspect of pancreatitis is its potential to cause severe and sometimes debilitating pain in the upper abdomen. This characteristic makes it a critical point of concern within this article. The acute form of this condition can develop suddenly and requires immediate medical intervention. Moreover, complications like pancreatic necrosis can significantly increase health risks, highlighting the need for awareness and management strategies.
Pancreatic Cancer
Pancreatic cancer, while less common, presents significant challenges in upper abdominal discomfort. It often progresses silently until later stages, which can complicate diagnosis and treatment. A key characteristic is unexplained weight loss and persistent abdominal pain. The unique feature of this condition is its often late diagnosis, which has a considerable impact on treatment outcomes. Thus, awareness and early detection strategies are vital.
Cardiovascular Issues
Angina
Angina refers to chest pain caused by reduced blood flow to the heart. This condition is a focus because it can manifest as upper abdominal discomfort, especially in cases where abdominal organs are affected. A key characteristic of angina is the sensation of pressure or squeezing in the chest, which may radiate to the abdomen. Its distinction, however, is crucial, as it indicates a need for cardiovascular evaluation to rule out significant heart issues.
Myocardial Infarction
Myocardial infarction, or heart attack, is a severe medical emergency. It can present with upper abdominal pain, which may mislead patients, thinking it is gastrointestinal in nature. Recognizing this aspect is critical for timely intervention. The key characteristic of a heart attack is sudden pressure or pain in the chest, which may accompany upper abdomen discomfort. Its unique feature is the potential for rapid deterioration, underscoring the importance of awareness in patients for appropriate medical responses.
Pulmonary Factors
Pneumonia
Pneumonia can present with symptoms that overlap with abdominal discomfort. This condition is marked by inflammation of the lungs and often leads to referred pain in the upper abdomen. The specific aspect of pneumonia is the presence of other respiratory symptoms, such as cough and fever. Its relevance to upper abdominal discomfort cannot be understated, as it requires recognition to avoid misdiagnosis.
Pulmonary Embolism
Pulmonary embolism is a life-threatening condition caused by a blood clot in the lungs. A critical aspect of this condition is the sudden onset of chest pain, which may mimic upper abdominal discomfort. This unique feature highlights the necessity of prompt evaluation to assess the nature of the pain accurately. Given the potentially fatal outcomes, understanding this condition is vital for both patients and healthcare providers.
Diagnostic Approach to Upper Abdominal Discomfort
The diagnostic approach to upper abdominal discomfort is crucial for identifying the underlying causes of this often complex symptom. Proper diagnosis can lead to effective management strategies and improve patient quality of life. The process typically involves several key components, including patient assessment, physical examination, laboratory investigations, and imaging modalities. Each of these plays a significant role in gathering information that can inform clinical decisions.
Initial Patient Assessment
History Taking
History taking is an essential component of the initial patient assessment. This process allows healthcare providers to gather detailed information about the symptoms and medical history of the patient. Key characteristics of history taking include open-ended questions, which encourage patients to share all related background information. This method is beneficial because it helps detect subtle patterns that may indicate specific conditions.
A unique feature of history taking is its ability to uncover psychosocial factors that may contribute to discomfort. Understanding a patient’s lifestyle, stress levels, and emotional health is valuable. However, the challenge lies in patients sometimes not recalling all details or omitting important aspects due to embarrassment. Despite these potential limitations, effective history taking remains crucial for forming an accurate picture of the patient's health.
Symptom Analysis
Symptom analysis complements history taking by focusing specifically on the nature of the discomfort experienced by the patient. This aspect of the initial assessment helps to pinpoint characteristics such as the location, severity, and duration of symptoms. The key characteristic of symptom analysis is its systematic approach, which can identify potential red flags that signal serious conditions.
Symptom analysis is also considered a beneficial choice in the diagnostic framework. It offers a structured method for healthcare professionals to evaluate the urgency and significance of reported issues. One unique feature is the ability to correlate the timing of symptoms with eating or other activities. This correlation helps determine if the discomfort may stem from gastrointestinal issues or other systemic problems. The downside can be patients’ subjective interpretation of their symptoms, which can lead to variability in response. Nevertheless, it is an indispensable part of the assessment process.
Physical Examination Techniques
Physical examination techniques bring a tactile dimension to the diagnostic process. These techniques allow healthcare providers to assess abdominal tenderness, organ size, and masses through physical touch. Such examinations can quickly indicate several conditions, such as inflammation or obstruction. The examination includes inspections, palpations, and percussion, which together provide insight into the patient's abdominal health.
Proper physical examination requires trained professionals to recognize signs accurately. While this approach is beneficial, its subjectivity may lead to different conclusions among different examiners. Overall, physical examination is an invaluable tool in the assessment of upper abdominal discomfort.
Laboratory Investigations
Laboratory investigations are pivotal in confirming or ruling out specific medical conditions contributing to upper abdominal discomfort. \Blood Tests are frequently ordered as they assess various parameters, including enzyme levels, inflammation markers, and infections. Blood tests are essential in evaluating the function of organs such as the liver and pancreas. A key characteristic is that they offer a big picture of the patient’s overall health, making them a valuable asset in the diagnostic toolkit. The unique feature of blood tests is their ability to detect conditions that might not present obvious symptoms initially. However, their limitations include possible false positives or negatives, meaning results need to be interpreted within the clinical context.
Stool Tests
Stool tests serve to assess gastrointestinal function and to identify potential infections or underlying diseases. These tests analyze the presence of blood, pathogens, or abnormal fat content, contributing to the understanding of the digestive tract's health. A significant aspect of stool tests is their non-invasive nature, making them more manageable and less daunting for patients.
The unique advantage of stool tests is their ability to reveal problems in the lower gastrointestinal tract that may contribute to upper abdominal symptoms. However, a disadvantage could be that not all conditions are detectable through stool analysis alone, necessitating further investigation.
Imaging Modalities
Imaging modalities provide visual insights into anatomical structures within the upper abdomen. They are essential for diagnosing conditions that physical exams or laboratory tests may not reveal.
Ultrasound
Ultrasound is a first-line imaging technique due to its safety and efficacy. It uses sound waves to create images of organs such as the liver, gallbladder, and pancreas. The key feature of ultrasound is its ability to detect fluid collections and biliary obstructions without the use of ionizing radiation. Its unique advantage is that it allows real-time evaluation, which can be immensely useful during patient assessment. However, the disadvantage is that certain aspects of the upper abdomen may not be well-visualized depending on patient factors like body habitus.
CT Scan
CT scans offer a more detailed view and are indispensable in acute settings. They provide cross-sectional images that allow detailed visualization of abdominal organs. A significant characteristic of CT scans is their speed and versatility in diagnosing a range of acute issues such as appendicitis, pancreatitis, or tumors. The advantage lies in their comprehensive nature, but the downside includes exposure to higher levels of radiation.
MRI
MRI is particularly helpful for soft tissue differences and can help diagnose conditions such as tumors or liver diseases with great detail. The key characteristic of MRI is its non-invasive nature, which does not involve radiation. The unique feature of MRI lies in its superior contrast resolution, allowing for excellent visualization of pathology. However, MRI may not be suitable for all patients due to cost and availability, limiting its use in everyday practice.
Thorough diagnostic approaches ensure the best outcomes when treating upper abdominal discomfort. By balancing history, examination, laboratory tests, and imaging, healthcare providers can deliver refined and targeted care.
Management Strategies for Upper Abdominal Discomfort
Management strategies for upper abdominal discomfort are crucial. They address both symptoms and underlying causes. By implementing these strategies, individuals can improve their overall health and quality of life. The approaches can vary widely and include lifestyle changes, pharmacological treatments, and guidance on when to seek further medical help.
Lifestyle Modifications
Dietary Changes
Dietary changes play a significant role in managing upper abdominal discomfort. Specific adjustments, such as reducing spicy foods or avoiding acidic items, can lead to a notable decrease in symptoms. For individuals experiencing gastroesophageal reflux or gastritis, these adjustments can be particularly beneficial.
A key characteristic of dietary changes is their non-invasive nature. Unlike medications, these alterations can often be adopted without a prescription. This makes dietary modifications a popular choice in this article, appealing to those looking for immediate and practical solutions. Unique features include the ability to track symptoms after each dietary change. This helps in identifying specific food triggers, allowing for a personalized diet plan. However, care must be taken to ensure that dietary changes do not lead to nutrient deficiencies.
Exercise Regimens
Exercise regimens contribute significantly to managing upper abdominal discomfort, particularly in reducing stress. Regular physical activity can strengthen abdominal muscles and improve digestion. Exercise such as walking, swimming, or yoga can enhance overall well-being and decrease discomfort.
The key characteristic of these regimens is their holistic approach. Exercise can benefit both physical and mental health, making it a beneficial choice for many individuals. A unique aspect of exercise is its adaptability; people can adjust the intensity and type according to their own fitness levels and preferences. However, not all exercises may be suitable for individuals with specific conditions, emphasizing the need for a tailored approach.
Pharmacological Treatments
Antacids
Antacids provide quick relief for symptoms caused by excess stomach acid. They work by neutralizing acid in the stomach, offering rapid symptom relief for conditions like heartburn and indigestion. Many over-the-counter options are available, making antacids a convenient choice for many individuals.
A key characteristic is their ease of access. Antacids can often be purchased without a prescription, which makes them readily available. Their unique feature is also their fast-acting nature. Many people find relief within minutes after taking antacids. However, frequent use can mask underlying conditions and may lead to side effects such as constipation or diarrhea.
Proton Pump Inhibitors
Proton pump inhibitors, or PPIs, provide a powerful means to suppress gastric acid production. Commonly prescribed for conditions like GERD and peptic ulcer disease, they offer longer-lasting relief compared to antacids. They work by blocking the acid pumps in the stomach lining, thereby significantly reducing acid output.
A key characteristic is their effectiveness for long-term management. PPIs are a beneficial option when symptoms are frequent and severe. Their unique benefit is their ability to heal erosive esophagitis over time. Nevertheless, long-term use has been associated with risks like vitamin deficiencies or bone fractures, making consultations with healthcare providers essential.
Analgesics
Analgesics are another important pharmacological option for managing pain associated with upper abdominal discomfort. Non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve the pain but should be used with caution. While they can reduce discomfort, they also have the potential to irritate the stomach lining.
A key characteristic of analgesics is their widespread availability and effectiveness in pain management. They are a popular choice, especially for those dealing with intermittent discomfort. The unique feature of analgesics is their ability to provide immediate pain relief. However, regular use can lead to complications such as gastrointestinal bleeding or ulcers, thus requiring careful monitoring.
When to Seek Additional Care
Knowing when to seek additional care is essential. If discomfort persists despite initial management strategies, further evaluation is necessary. Warning signs include severe pain, unexplained weight loss, difficulty swallowing, or if symptoms worsen over time. Consulting a healthcare provider in such cases can ensure that any serious underlying conditions are addressed promptly.
Always consult a healthcare professional if you have any concerns about your health especially if symptoms are severe or changing.
Psychological Factors and Upper Abdominal Discomfort
Understanding the psychological factors that contribute to upper abdominal discomfort is critical for both diagnosis and management. There is a significant correlation between mental health and physical symptoms. Conditions such as anxiety and depression can manifest as physical discomfort, including pain in the upper abdomen. Hence, addressing these psychological aspects can improve the treatment outcomes for those suffering from such symptoms.
Stress and Emotional Health
Stress plays a pivotal role in various gastrointestinal disorders. Stressful life events can trigger or exacerbate conditions like gastritis and functional dyspepsia. When under stress, the body releases cortisol, a hormone that affects multiple systems, including the digestive system. Higher cortisol levels can lead to inflammation and altered gut function, which may result in discomfort.
Emotional health significantly influences how a person experiences abdominal discomfort. Patients may interpret physiological sensations differently depending on their emotional state. For instance, someone facing high levels of anxiety might perceive normal gastric sensations as severe pain. This misunderstanding can contribute to a cycle of stress and intensified discomfort.
Furthermore, effective stress management techniques, like mindfulness practices or cognitive behavioral therapy, can facilitate improvement in abdominal symptoms. By addressing the underlying emotional issues, patients often report a reduction in discomfort.
Somatic Symptom Disorders
Somatic symptom disorders occur when an individual experiences physical symptoms that cannot be fully explained by a medical condition. These symptoms are real and can include persistent pain in the abdominal area. Patients may exhibit an intense focus on the discomfort, leading to increased anxiety and further exacerbation of symptoms.
These disorders illustrate the complex interplay between mind and body, emphasizing the need for a multi-disciplinary approach to treatment. Psychological evaluation and therapy can be essential for managing somatic symptoms effectively. In many cases, integrated care that includes psychological support alongside traditional medical treatment yields the best results.
Preventative Measures
Preventative measures play a crucial role in managing upper abdominal discomfort. They help in minimizing the incidence of conditions that lead to such discomfort. Healthy lifestyle choices can significantly reduce the risk of several gastrointestinal and related disorders. The significance of prevention cannot be overstated; it enhances quality of life and decreases healthcare costs associated with treating chronic conditions.
Furthermore, an active approach to maintaining health can empower individuals to recognize symptoms early. This understanding can lead to timely interventions and prevent the escalation of medical issues.
Regular Health Screenings
Regular health screenings are essential for early detection of potential health issues. They help identify asymptomatic conditions that could contribute to upper abdominal discomfort. For example, screenings for hepatitis, diabetes, and even certain cancers can be vital in managing long-term health. By recognizing these conditions early, individuals can make informed decisions about their health.
Health screenings should be tailored to individual risks. Age, family history, and lifestyle factors all influence the frequency and type of screening needed. For instance, individuals with a family history of gastrointestinal problems may require more frequent evaluations than those without such history.
"Prevention is better than cure." Regular screenings are a proactive step toward sustaining health and preventing discomfort.
Education on Symptoms
Education on symptoms related to upper abdominal discomfort is integral to effective management. Understanding what constitutes abnormal sensations or pain can guide individuals in seeking appropriate care. This knowledge provides insight into recognizing symptoms that warrant medical attention.
For example, persistent pain, changes in digestion, or symptoms like jaundice or unexplained weight loss should not be ignored. Recognizing these may prompt individuals to consult a healthcare provider who can conduct further evaluations.
Additionally, educational resources, including workshops or informational materials, can provide clarity on signs and symptoms. This helps in demystifying various health conditions that might cause discomfort. With better education, patients can communicate more effectively with healthcare professionals, contributing to comprehensive care plans.
In summary, focus on preventative measures enhances the understanding and management of upper abdominal discomfort. Regular health screenings and education on symptoms equip individuals with the tools necessary to navigate their health journey. These steps ultimately foster a proactive health mindset.
Culmination
The conclusion serves as a crucial element in this article on upper abdominal discomfort. It synthesizes the complexities discussed across all sections, providing a clear understanding of why addressing this issue matters. Upper abdominal discomfort can arise from various causes, making it vital for individuals to recognize symptoms and seek timely medical attention.
Summary of Key Points
In summary, the article highlighted several significant aspects related to upper abdominal discomfort:
- Common Causes: We explored gastrointestinal conditions such as peptic ulcer disease and GERD, biliary disorders like cholecystitis, and cardiovascular issues including angina.
- Diagnostic Approach: The importance of a thorough patient assessment, including symptom analysis, physical examinations, and imaging techniques, were emphasized.
- Management Strategies: Lifestyle modifications, pharmacological options, and knowing when to seek further medical care were discussed as critical to managing upper abdominal discomfort.
By summarizing these key points, readers can better appreciate the interconnectedness of them. Recognizing the array of causes allows for a more focused approach to treatment.
Future Directions in Research
Future research on upper abdominal discomfort should concentrate on several aspects:
- Innovative Diagnostic Techniques: There is a need for more advanced imaging modalities and laboratory tests to differentiate among conditions that present with similar symptoms.
- Longitudinal Studies: Research that follows patients over time would provide insights into the long-term effects of upper abdominal discomfort and its varied causes.
- Impact of Psychological Factors: Understanding the psychological dimensions better can lead to improved treatment protocols that consider mental health alongside physical health.
Continued exploration of these areas can enhance clinical understanding and patient care, thus improving outcomes for those suffering from upper abdominal discomfort.
