Persistent Vomiting and Stomach Burning: Causes and Urgent Care Guide

Vomiting after every meal with burning epigastric pain is a red flag requiring prompt medical evaluation. Do not self-treat.

Potential Causes

1. GERD: Acid reflux causing esophagitis, worse after eating/lying down.
2. Peptic Ulcer Disease: H. pylori or NSAID-induced gastric/duodenal ulcers; burning pain, often relieved then worsened by food.
3. Gastroparesis: Delayed gastric emptying (diabetes, post-viral); nausea, vomiting undigested food, early satiety.
4. Gastric Outlet Obstruction: From ulcer scarring, tumor, or pyloric stenosis; projectile vomiting.
5. Pancreatitis: Severe epigastric pain radiating to back, vomiting, elevated lipase.
6. Biliary Disease: Gallstones, cholangitis; RUQ pain, fever, vomiting.
7. Medication Side Effects: Opioids, antibiotics, chemo, NSAIDs.
8. Food Allergy/Intolerance: Celiac, lactose intolerance, eosinophilic esophagitis.
9. Neurologic: Increased intracranial pressure, vestibular migraine.
10. Psychogenic: Cyclic vomiting syndrome, eating disorders.

When to Seek Emergency Care

• Hematemesis (blood in vomit) or "coffee grounds" material.
• Signs of dehydration: dizziness, dry mouth, low urine output.
• Severe abdominal pain, rigidity, or distension.
• Fever > 38.5°C (101.3°F).
• Neurologic symptoms: confusion, severe headache, visual changes.

Diagnostic Approach

History, physical, labs (CBC, BMP, LFTs, lipase, hCG), imaging (abdominal X-ray, CT, endoscopy).