The Burning Truth: Exploring Frequent Stomach Discomfort

The Burning Truth: Exploring Frequent Stomach Discomfort

by Catherina Pascale

Abstract

A frequent burning sensation in the stomach is a common complaint in primary care and gastroenterology. It is often described as gnawing, acidic, or epigastric discomfort. This symptom is most frequently associated with gastroesophageal reflux disease (GERD), functional dyspepsia, gastritis, and peptic ulcer disease, but may also result from less common etiologies such as biliary tract disorders or gastric malignancy. Understanding the underlying pathophysiology is essential for accurate diagnosis, effective management, and prevention of complications.

This article gathers current evidence from high-quality studies and clinical guidelines, providing an overview of epidemiology, mechanisms, diagnostic strategies, management approaches, and preventive interventions. An emphasis is placed on patient-centered care, including practical education tools to help individuals manage symptoms, recognize warning signs, and optimize lifestyle habits.

Attached to this article is a flowsheet summarizing information with suggestions for a simple Symptom Diary to help individuals better understand their condition. This will also help in giving clear information to health professionals when seeking medical help.

Introduction

The burning sensation localized in the upper abdomen, especially in the epigastric region that is just below the sternum, is a symptom that prompts millions of medical visits annually. In the United States, dyspeptic symptoms affect approximately 20% of the population, with a significant proportion experiencing persistent or recurrent discomfort (Ford et al., 2020). While many cases have benign causes, persistent gastric burning may signal more serious pathology, underscoring the need for thorough clinical evaluation.

From a patient’s perspective, this symptom can significantly impair quality of life, disrupt eating habits, and cause anxiety about potential underlying disease. From a public health perspective, understanding and managing frequent gastric burning is important not only to relieve discomfort but also to prevent complications such as gastrointestinal bleeding or gastric cancer in high-risk individuals.

Etiology and Pathophysiology

1. Functional Dyspepsia (FD)

Functional dyspepsia is characterized by persistent or recurrent epigastric discomfort without structural disease on endoscopy or imaging. It is considered a disorder of gut–brain interaction, with multiple pathophysiological mechanisms:

• Visceral hypersensitivity – heightened sensitivity of the stomach lining to normal stretching or chemical stimuli (Enck et al., 2017).

• Impaired gastric accommodation – reduced ability of the stomach to relax after a meal, leading to early satiety.

• Delayed gastric emptying – prolonged retention of food, causing distension and discomfort.

• Low-grade mucosal inflammation – mild infiltration of immune cells, sometimes linked to post-infectious states.

• Microbiome alterations – changes in stomach or small intestinal bacterial populations potentially influencing motility and sensitivity.

Although benign, FD often causes chronic distress, and symptoms may overlap with GERD or gastritis which can complicate diagnosis (Van Oudenhove, et al., 2016).

2. Gastroesophageal Reflux Disease (GERD)

GERD occurs when gastric contents reflux into the esophagus, causing mucosal irritation and symptoms such as heartburn (a retrosternal burning sensation) and regurgitation. Epigastric burning may accompany or substitute for classic heartburn, especially in patients with overlapping FD or atypical presentations.

Key contributing factors include:

• Lower esophageal sphincter (LES) hypotension

• Transient LES relaxations unrelated to swallowing

• Hiatal hernia

• Increased intra-abdominal pressure (e.g., obesity, pregnancy)

Untreated GERD may lead to complications such as erosive esophagitis, Barrett’s esophagus, or strictures (Vakil et al., 2006).

3. Gastritis

Gastritis refers to inflammation of the gastric mucosa, which may be acute or chronic. Causes include:

• Helicobacter pylori infection – a spiral-shaped bacterium that colonizes the stomach lining and triggers inflammation (Suerbaum & Michetti, 2002).

• NSAID use – inhibits prostaglandin synthesis, reducing mucosal protection.

• Alcohol and irritant foods – direct mucosal injury.

• Autoimmune gastritis – immune-mediated destruction of parietal cells.

Histological changes range from superficial inflammation to atrophy and intestinal metaplasia, the latter carrying an increased cancer risk (Saleem, et. al., 2025).

4. Peptic Ulcer Disease (PUD)

Peptic ulcers are mucosal breaks in the stomach or proximal duodenum, often due to H. pylori or NSAID use (Malfertheiner et al., 2017). Epigastric burning is a hallmark symptom, sometimes occurring in rhythmic relation to meals:

• Gastric ulcers – pain often worsens with food.

• Duodenal ulcers – pain may improve temporarily with eating but returns within hours.

Complications include bleeding, perforation, and gastric outlet obstruction (John Hopkins Medicine, 2024).

5. Helicobacter pylori and Gastric Cancer Risk

H. pylori is classified as a Group 1 carcinogen by the International Agency for Research on Cancer. It plays a central role in chronic gastritis, PUD, and gastric carcinogenesis (Ford et al., 2020).

Eradication therapy should be suggested to patients who test positive to Helicobacter pylori. Eradication therapy is a treatment plan, usually combining two antibiotics and an acid-reducing medicine, to completely remove H. pylori bacteria from the stomach (Vakil and Magraud, 2007).

Diagnosis

When stomach or digestion problems occur, doctors follow a step-by-step approach to find the cause and treat it early. They start by asking about your symptoms—when they began, whether they come and go, and if they get better or worse after eating. They will ask about other symptoms such as nausea, vomiting, bloating, feeling full quickly, or changes in weight, and watch for warning signs such as blood in vomit or stools, trouble swallowing, or ongoing vomiting. They will also review any medicines you take, such as painkillers or steroids, and ask about alcohol, caffeine, smoking, and family history of stomach problems. A physical exam may be normal but can show tenderness in the upper stomach, signs of anemia, or weight loss. Blood tests can check for anemia, and other tests can look for H. pylori bacteria or rule out liver and gallbladder problems. In some cases, a camera test called an endoscopy is needed, especially for older adults, people with warning signs, or those whose symptoms do not improve. This test also allows the doctor to take a sample for further study (Black, et. al., 2018).

Management Strategies

Treating stomach and digestion problems usually involves both medicines and lifestyle changes. The most effective medicines to reduce stomach acid are called proton pump inhibitors (PPIs), which help with conditions such as acid reflux, gastritis, and stomach ulcers (Freedberg et al., 2017). For milder symptoms, another type of acid-reducing medicine called H2 blockers may be enough, and medicines that help food move through the stomach (prokinetics) can help in certain cases. Antacids or alginate products work quickly to relieve discomfort, but the effect does not last long. If the problem is caused by H. pylori bacteria, a special treatment called eradication therapy—usually a mix of two antibiotics and an acid-reducing medicine—is used to clear the infection. Lifestyle changes also play a big role, such as avoiding foods and drinks that trigger symptoms, including spicy, fatty, or acidic foods, caffeine, chocolate, and alcohol. Eating smaller meals more often and staying upright for at least three hours after eating can help. Losing extra weight is especially helpful for acid reflux. Quitting smoking can speed healing and reduce symptoms (Weiser, 2025). In some cases, stress management techniques such as cognitive-behavioral therapy or relaxation methods can help lessen how strongly symptoms are felt (Van Oudenhove et al., 2016).

Conclusion

Frequent burning sensation in the stomach is common, however there are various factors that contribute to this symptom. While GERD, functional dyspepsia, gastritis, and peptic ulcer disease account for most cases, careful assessment is essential to exclude serious disease. Modern management requires integrating pharmacologic therapy, lifestyle modification, and patient education. Empowering patients with clear tools for self-monitoring, safe medication use, and recognition of alarm symptoms enhances both short- and long-term outcomes. Clinicians should individualize care plans, address overlapping pathophysiologic mechanisms, and maintain vigilance for evolving guidelines.

References

Black, C. J., Houghton, L. A., & Ford, A. C. (2018). Insights into the evaluation and management of dyspepsia: recent developments and new guidelines. Therapeutic advances in gastroenterology, 11, 1756284818805597. https://doi.org/10.1177/1756284818805597

Enck, P., Aziz, Q., Barbara, G., Farmer, A. D., Fukudo, S., Mayer, E. A., ... & Spiller, R. C. (2017). Functional dyspepsia. Nature Reviews Disease Primers, 3, 17081. https://doi.org/10.1038/nrdp.2017.81

Ford, A. C., Mahadeva, S., Carbone, M. F., Lacy, B. E., & Talley, N. J. (2020). Functional dyspepsia. The Lancet, 396(10263), 1689–1702. https://doi.org/10.1016/S0140-6736(20)30469-4

Freedberg, D. E., Kim, L. S., & Yang, Y. X. (2017). The risks and benefits of long-term use of proton pump inhibitors: Expert review and best practice advice from the American Gastroenterological Association. Gastroenterology, 152(4), 706–715. https://doi.org/10.1053/j.gastro.2017.01.031

Johns Hopkins Medicine. (2024, September 11). Stomach and duodenal ulcers (peptic ulcers). https://www.hopkinsmedicine.org/health/conditions-and-diseases/stomach-and-duodenal-ulcers-peptic-ulcers

Malfertheiner, P., Megraud, F., Rokkas, T., Gisbert, J. P., Liou, J. M., Schulz, C., ... & Sugano, K. (2017). Management of Helicobacter pylori infection—the Maastricht V/Florence Consensus Report. Gut, 66(1), 6–30. https://doi.org/10.1136/gutjnl-2016-312288

Saleem, Ahmed & Rasheed, & Tahzeeb, Ansari & Ansari, Shadiya & Sajjad, & Rashid, Siddiqui & Ahmad, Rafeeque. (2025). Gastritis: Etiology, Pathophysiology, Diagnosis, and Management. 13. 1-14.

Suerbaum, S., & Michetti, P. (2002). Helicobacter pylori infection. New England Journal of Medicine, 347(15), 1175–1186. https://doi.org/10.1056/NEJMra020542

Vakil, N., van Zanten, S. V., Kahrilas, P., Dent, J., & Jones, R. (2006). The Montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. American Journal of Gastroenterology, 101(8), 1900–1920. https://doi.org/10.1111/j.1572-0241.2006.00630.x

Vakil, Nimish and Megraud, Francis. (2007) Eradication Therapy for Helicobacter pylori. Gastroenterology, Volume 133, Issue 3, 985 – 1001. https://doi.org/10.1053/j.gastro.2007.07.008

Van Oudenhove, L., Levy, R. L., Crowell, M. D., Drossman, D. A., Halpert, A. D., Keefer, L., ... & Talley, N. J. (2016). Biopsychosocial aspects of functional gastrointestinal disorders. Gastroenterology, 150(6), 1355–1367. https://doi.org/10.1053/j.gastro.2016.02.027

Weiser, P. (2025, May 14). 5 best acid reducers for heartburn 2025 | U.S. News. USNews Health. https://health.usnews.com/otc/rankings/acid-reducers

Here is a flowsheet for a summary of the information:

Burning in the Stomach: What You Need to Know

A frequent burning feeling in your stomach or upper belly is often due to extra stomach acid or irritation of your stomach lining or esophagus (food pipe). It is common, but sometimes it can be a sign of something that needs medical attention.

Common Causes

• Acid reflux (GERD) – acid flows back into the esophagus

• Gastritis – irritation or inflammation of the stomach lining

• Peptic ulcer – a sore in the stomach or upper small intestine

• Functional dyspepsia – burning or discomfort with no clear cause on tests

• Certain medicines – such as aspirin, ibuprofen, or steroids

• Infection – Helicobacter pylori bacteria

What You Can Do at Home

 - Eat smaller, more frequent meals - Avoid lying down for at least 3 hours after eating

Limit foods that often cause burning:

• Spicy or fried foods

• Citrus, tomatoes, vinegar

• Coffee, tea, chocolate, alcohol

 - Maintain a healthy weight - Quit smoking - Try an antacid for quick relief (follow package instructions)

When to Call Your Doctor Right Away

Seek help immediately if you have:

• Vomiting blood or coffee-ground–like material

• Black, tarry, or bloody stools

• Sudden, severe stomach pain

• Trouble swallowing

• Unexplained weight loss

• Ongoing vomiting

• Feeling weak, dizzy, or faint

It can help you, and your doctor, to better understand the causes and how to manage the problem by keeping a simple diary to record your symptoms. It may be useful to include more than one entry during the day over a short period of time. Here is a suggestion of the information to record:

Your Symptom Diary

Date

Time

What I ate/drank

Activities

Symptoms (rate 0/10)

Notes

Remember: Always check with your healthcare provider about your symptoms and treatments.

Assessed and Endorsed by the MedReport Medical Review Board