When Your Tummy Rebels: Understanding the Top 13 Culprits Behind Digestive Distress

1. Gastritis
2. Esophagitis (pron. eh-so-vaj-itis).
3. Ulcers
4. Appendicitis
5. Kidney problems
6. Pancreatitis
7.  Acute cholecystitis
8. Ectopic Pregnancy
9. Ovarian Torsion
10. Diverticulitis
11. Cardiac problems
12. Cyclic vomiting syndrome (CVS) and abdominal migraine.
13. Cannabis Hyperemesis Syndrome (CHS)
14. Summary

Nausea, vomiting, and abdominal cramps that knot up your tummy and make you afraid to move. These are a few of the symptoms that go along with a myriad of ailments. Some may be as mild as a gastrointestinal bug that goes away on its own, usually within a few days. Other diagnoses can be more serious, requiring emergency surgery. Here are a few of the conditions that may be the culprit of your distress.

1. Gastritis

Gastritis means “inflammation of the stomach lining.” Common causes are stress, taking certain medications like aspirin/ibuprofen or other nonsteroidal anti-inflammatory medications (NSAIDs), alcohol, smoking, family history, and infection with a bacteria called Helicobacter pylori(H. Pylori).

Gastritis causes abdominal pain, usually in the upper part of the abdomen and often towards the center. The pain is usually constant, although it can get worse when you eat acidic foods (like tomatoes or citrus juice) or when your stomach is empty.

Gastritis can improve for a while after you eat, and you may also feel better after taking antacids.

While nausea can occur with gastritis, frequent vomiting is uncommon.

Your doctor might order tests like an upper endoscopy (EGD) or upper gastrointestinal series (UGI) to check this diagnosis further. Or, your doctor may start by treating you with medications such as Histamine2(H2) Blockers or Proton Pump Inhibitors (PPIs), depending on the severity of your condition.

2. Esophagitis (pron. eh-so-vaj-itis).

Esophagitis is an “inflammation of the esophagus”. Your esophagus is the tube that connects your throat to your stomach. The foods we eat all travel through our esophagus.

Causes of esophagitis include acid reflux (GERD) and taking certain over-the-counter medications like aspirin, ibuprofen, or other anti-inflammatory medications (NSAIDs). Certain antibiotics, such as tetracycline. Medications used to treat osteoporosis such as bisphosphonates like alendronate and risedronate. Alcohol, smoking, infections of the esophagus, and radiation treatment are all possible causes.

Acid reflux is a condition where acid from your stomach travels up into your esophagus, where it should not be. The acid damages the delicate tissue that lines the esophagus.

Esophagitis pain can go from your upper abdomen into your chest and jaw. It can be burning but can also be sharp or tight. It may hurt when food is passing through the esophagus on the way to your stomach.

Antacids can make esophagitis feel better temporarily, as can eating small/frequent meals, avoiding eating right before bed, and sleeping with the head of your bed elevated by 6 inches.

Your doctor might order tests like an EGD or UGI to check for esophagitis. Your doctor may also give you medications if they suspect this condition.

Although uncommon, untreated chronic esophagitis can cause esophageal cancer.

3. Ulcers

Ulcers are a more severe form of gastritis. The causes are the same.  Stomach ulcers cause pain that is burning, dull, or gnawing, like hunger pain.

With ulcers, the stomach lining is often damaged only in a small location. But with gastritis, the damage can be widespread. However, the damage goes deeper with an ulcer. Ulcers can even go all the way through your stomach lining.

Bleeding can occur with gastritis, esophagitis, and ulcers, but the risk for serious bleeding is higher with ulcers.

Your doctor might order tests like an EGD or UGI to make this diagnosis. They might order a test for Helicobacter pylori, a breath or stool test. Or they might start by treating you with medications depending on the severity of your condition.

4. Appendicitis

Appendicitis is an inflammation of the appendix caused by blockage. The appendix is a small organ, like a small tube, located at the beginning of your large intestine.

Most people who get appendicitis start with abdominal pain in the center of their abdomen that spreads down into the right lower part of the abdomen. It gradually gets worse over hours or days. Nausea and eventually vomiting occur, and often, fever.

In some people, the pain can be in different places, even on the left side. If you have appendicitis, you need emergency treatment, likely surgery, to prevent the appendix from rupturing or breaking open. Without treatment, you can die from appendicitis. Once your appendix is out, you can never get this again, so you should not expect repeated episodes.

If your doctor thinks you have this, they will order blood tests to check for inflammation and evaluate other organs in your abdomen. They may also order a urine test for kidney stones or infection and an abdominal scan like a computerized tomography (CT) scan to look for an inflamed appendix.

5. Kidney problems

This includes kidney stones or infections. Both can occur suddenly but often get worse.

The pain is usually located in the back, a little below the bra line, but can be anywhere in the abdomen. Usually, it is just on one side. Nausea is common, and vomiting can occur, especially if the pain is severe. Fevers can occur with infection. You may develop changes in your urine, such as blood, cloudiness, or abnormal odor.

Infections are common in women. Men who get infections in the urinary system, including the kidneys, are more prone to having another cause, such as a prostate problem.

Your doctor will order a urine test to look for blood, pus, and bacteria in the urine. They may order scans such as an X-ray, abdominal ultrasound (US), or CT if they think you have a kidney stone.

Sometimes, people can be prone to kidney problems, so they can recur weeks, months, or years later.

6. Pancreatitis

An inflammation of your pancreas causes pancreatitis. The main causes of pancreatitis are excessive alcohol intake, gallstones, and certain medications.

The pain is usually in the central part of your abdomen. It can also be the upper abdomen, but not usually on just one side. It can radiate to your back. It can be severe and is often worse with eating. Leaning forward or curling up into a ball may make it feel better. Nausea and vomiting can occur. Sometimes, the symptoms will settle on their own, only to return weeks or months later.

Your doctor can order blood tests to look for inflammation of your pancreas. They can also order scans like a CT scan to look at your pancreas for signs of this condition.

7. Acute cholecystitis

This is “inflammation of the gallbladder,” usually caused by gallstones.

Your gallbladder produces bile, which helps your body with digestion, especially fatty foods. If you have a stone in the bile of your gallbladder, it can get stuck in a narrow part of the duct or tube that connects the gallbladder to the intestine. When the duct gets blocked like this, you get pain, and the gallbladder can get inflamed.

The pain is usually severe and steady and located on the right side of your upper abdomen. Sometimes, it can be in the central part of your upper abdomen. Nausea, vomiting, and fever can occur. Jaundice, a yellow discoloration of the skin and eyes, can also be present.

A fatty meal can trigger acute cholecystitis. Sometimes, the stone will pass on its own, but you could have another attack if another stone gets stuck in the duct.

Your doctor can order blood tests and imaging, such as an abdomen ultrasound, to look for signs of cholecystitis.

8. Ectopic Pregnancy

An ectopic pregnancy is where the embryo is growing outside your uterus. This is often in either the right or left fallopian tubes. Because the embryo is in the wrong place, it cannot grow normally. As the pregnancy grows, it will break through the fallopian tube and cause internal bleeding. When this happens, this is called a ruptured ectopic pregnancy. This is a life-threatening condition for which emergency care is necessary.

Abdominal pain and vaginal bleeding are the two most common symptoms of an ectopic pregnancy. Nausea and vomiting can also occur. The abdominal pain is often in the lower abdomen on one side. The pain can also be in right shoulder. The pain will eventually be all over the abdomen as the condition worsens. The pain can be mild to severe.

9. Ovarian Torsion

Ovarian torsion is when your ovary gets twisted around its connections to your pelvis, cutting off its blood supply. It can occur in anyone but is more likely if you have a large cyst or tumor on your ovary.

Ovarian torsion happens very suddenly with pain, nausea, and vomiting.  The pain is in the lower abdomen and is often, but not always, one-sided. It is usually moderate to severe. The pain can travel to your back or groin area.

Sometimes, vigorous physical activity can trigger ovarian torsion. Mild fever can occur, but this is uncommon.

Because the pain associated with ovarian torsion is severe, you will likely go to the emergency room for evaluation. In the ER, the doctor will take your history, perform a physical exam, and do blood tests and an ultrasound.  Ovarian torsions are surgical emergencies.

In surgery, your doctor will untwist your ovary. They will remove any large cysts. Removal of the entire ovary may be necessary if the prolonged lack of blood flow causes the ovary to die.

If you are left with one healthy ovary, your body will continue functioning normally.

10. Diverticulitis

A diverticulum is an outpouching of your intestinal wall. These little pouches can get infected. When this happens, you have “diverticulitis.”

Smoking, obesity, and a low-fiber diet are all known risk factors. Sometimes, diverticulitis can be associated with cancer of the colon. Diverticulitis is usually found in people who are 40 or older.

The pain of diverticulitis is usually in your lower abdomen, on the left side, but sometimes can be on the right or central part of your lower abdomen. Nausea and sometimes vomiting can occur. Mild fevers can also occur. Bowel changes are common and can include diarrhea or constipation.

Your doctor may order urine tests, blood tests, or imaging such as an ultrasound or CT (CAT) scan of your abdomen and pelvis. The degree of testing needed will depend on the severity of your symptoms and how sure your doctor is that this is what you have.

Once you have recovered from diverticulitis, your doctor may recommend a colonoscopy to screen for colon cancer. This will depend on when you last had a colonoscopy, your colon cancer risk, and the severity of your diverticulitis.

11. Cardiac problems

Cardiac problems, including heart attacks. While heart problems, such as heart attacks, usually cause symptoms in the chest, such as chest pain and shortness of breath, occasionally, you could have a heart attack that causes pain in your upper abdomen instead of your chest.

Nausea is common with heart problems, as is shortness of breath. Vomiting can occur but less often. Cardiac problems tend to worsen when you exert yourself and sometimes feel better if you rest.

It can be difficult to distinguish if a heart condition is causing abdominal symptoms. Your doctor may order blood tests for the heart and an electrocardiogram (EKG) if they suspect a heart problem. You are at increased risk for heart problems if you have problems such as diabetes, high blood pressure, high cholesterol, prior heart problems, a family history of heart disease, or smoking.

12. Cyclic vomiting syndrome (CVS) and abdominal migraine.

These two conditions are closely related. Some think they may even be different versions of the same problem. They both seem very similar to cannabis hyperemesis syndrome and may be related to it. However, cannabis use does not affect CVS or abdominal migraine.

Both conditions are more common in children but are getting diagnosed more in adults than they used to be. Children with CVS or abdominal migraine often develop more traditional migraine headache disorders as they get older. A family history of migraines is very common with these conditions.

These two conditions involve attacks of abdominal pain, usually centrally located, nausea, and vomiting. They tend to last several hours to some days. Each attack is very similar to the others, and they recur after some weeks or months. CVS tends to have more vomiting than abdominal pain, and abdominal migraine tends to have more pain than vomiting.

Typical migraine triggers, such as stress, certain foods, menses, overexertion, hot weather, or dehydration, can trigger CVS and abdominal migraines.

There are no tests specific for either of these conditions. Doctors diagnose them by identifying the typical symptoms. Tests can rule out other possible diagnoses.

13. Cannabis Hyperemesis Syndrome (CHS)

Use of large volumes of cannabis for years can cause nausea, vomiting, and abdominal pain. It is not clear why this is. One theory is that the amount of tetrahydrocannabinol (THC) in marijuana has increased over the years compared to CBD. This increase may lead to increased rates of cannabis users getting ill. Another theory is that the prolonged use of cannabis may damage or change the portions of your brain that control nausea and vomiting. We know that CHS can be cured once you stop the use of cannabis.

Summary:

Common Causes of Abdominal Pain

Problem	Causes	Better With	Worse With	Treatment
Gastritis/ Esophagitis and Ulcers	Alcohol, NSAIDs, smoking, family history, H. Pylori infection	Small meals and antacids	Empty stomach, acidic foods	Medicines or endoscopy
Appendicitis	Blockage of the appendix		Sudden movements such as jumping, running, walking	Surgery
Kidney stones and/or infection	Infection, family history, diet.		Urination	Medicines or procedures to remove or break up stones.
Pancreatitis	Alcohol, gall- stones, meds	Leaning forward	Eating	Medicines
Acute chole- cystitis	Gall- stones		Fatty Meal	Medicines or surgery
Ectopic Pregnancy	Adhesions or infection around fallopian tubes.			Medicines or surgery
Ovarian torsion	A cyst or tumor growing on your ovary			Surgery
Diverticulitis	Low fiber diet. Colon cancer.	Usually occurs in people over age 40.		Medicines or surgery
Heart problems	Family history, smoking, high cholesterol, diabetes, high blood pressure	Physical exertion	Rest	Medicines or surgery
Cyclic vomiting syn- Drome (CVS) and abdo- mInal migraine	Unknown	Hot baths/showers.	Dehydration, stress, menses, ever-exertion,  hot weather.	Medicines
CHS	Heavy, regular marijuana use	Stopping marijuana use. Hot baths/showers.	Continued marijuana use.	Medicines, stopping THC use

This chart summarizes some of the above-discussed aspects of the different causes of abdominal pain and vomiting. Be aware that exceptions to rules are common in medicine. Just because your symptoms seem to either “fit” or “not fit” with any of these problems doesn’t mean that you do or don’t have one of these problems.

Use this guide to help you gain some understanding of these conditions and to prepare your questions at your doctor’s visit. Each body is unique, and each process can have variation. Uncontrolled pain, nausea, or vomiting is a sign that something in your body is not right. You must get this evaluated.

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Copyright: myObMD, Inc | Author: Lisa Shephard, MD | Editor: Jennifer Abayowa and Dayna Smith, MD | Reviewed September 29, 2023.

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