As for prevention, this obviously follows on from the detailed aetiological factors mentioned in
this chapter, particularly those regarding diet and eating habits.

Western Differentiation

From the perspective of a Western medical diagnosis the most important task is to differentiate
between the organs from which the epigastric pain may stem. These can be:

• oesophagus (carcinoma of oesophagus)


• stomach (gastritis, gastric ulcer, perforated ulcer, carcinoma of stomach)


• duodenum (duodenal ulcer)


• pancreas (pancreatitis and carcinoma of pancreas)


• large intestine (appendicitis).

Oesophagus

Carcinoma of Oesophagus

This manifests with epigastric and sternal pain and dysphagia (difficulty in swallowing). In
Western countries it occurs mostly in the elderly, whilst in China it is the commonest cancer of
the alimentary canal.

Stomach

Gastritis

This disease is confined to adults. It consists in inflammation of the stomach mucosa. It can be
superficial (affecting only the superficial layers) or atrophic (with thinning of the mucosa).

The main manifestations are a diffuse and constant epigastric pain which occurs about 1 hour
after eating, nausea, vomiting, sour regurgitation, belching and poor appetite. The tongue is
coated and, in acute cases, there may be a slight temperature. In severe, acute cases there might
be prostration and fainting as in shock with pallor and a rapid and feeble pulse.