Upper Abdominal Discomfort: Gas or Acid?

One of the most common complaints in gastroenterology is upper abdominal discomfort, pain and a sense of fullness that may or may not be associated with belching, bloating and gas. We are accustomed to thinking that any upper abdominal discomfort, including pain under the left rib cage and discomfort at the bottom of the sternum, are related to excessive acid or reflux. However, many people come to find out that antacids do not alleviate the discomfort. Some people take antacids for months without any benefit.

This lack of response may be observed because the cause for the discomfort is not excess acid but build up of gas. When air builds up around the turns of the colon, such as where the colon bends under the spleen (splenic flexure), air traps there and causes pain under the left rib cage. This phenomenon is called splenic flexure syndrome. The pain may radiate to the back and the scapula. The same may occur around the turn the colon takes under the liver (hepatic flexure. One of the most common reasons for such gas build up is constipation. If you tend to get constipated, skipping days of bowel movements, or having hard stools, you may want to try preparations to soften bowel movements, such as magnesium supplements, stool softeners, and miralax.

Pay attention to fibrous foods you are eating – some of them can increase gas pains. Try to increase soluble fiber and decrease insoluble fiber in your diet to minimize gas pains.

Upper abdominal discomfort may be confusing to discern. If your symptoms are primarily in the chest, causing burning or regurgitation, particularly after eating, acid reflux is a likely explanation and antacids are worth a try. If your discomfort is under the rib cage it is more likely to be related to gas buildup. If you are losing weight, have trouble swallowing, or if over the counter medications are not helping you, you should seek medical advice.