Persistent Postprandial Stomach Pain: 8 Differential Diagnoses and Workup

Recurrent pain after eating warrants systematic evaluation.

Common Causes

1. Food Intolerance/Allergy: Lactose, fructose, gluten, histamine – bloating, pain, diarrhea.
2. GERD: Heartburn, regurgitation, epigastric pain post-meals; worse lying down.
3. IBS: Pain + altered bowel habits (Rome IV criteria); meals trigger.
4. Peptic Ulcer (Gastric/Duodenal): Burning/gnawing epigastric pain; gastric ulcer worsens with food, duodenal relieves then recurs.
5. Acute Gastroenteritis / Food Poisoning: Nausea, vomiting, diarrhea, fever – self-limited.
6. Pancreatitis: Severe epigastric → back pain; worse after fatty meals; ↑ lipase/amylase.
7. Biliary Colic / Cholecystitis: RUQ pain post-prandial (fatty meals); ultrasound for stones.
8. Functional Dyspepsia: Chronic epigastric pain/bloating without structural cause (Rome IV).

Diagnostic Approach

• History + physical → targeted labs (CBC, LFTs, lipase, H. pylori, celiac serology).
• Imaging: US (RUQ), CT (pancreas), endoscopy (ulcer, GERD, functional).
• Breath tests (lactose, fructose, SIBO).

Do not self-treat chronically. See a gastroenterologist for persistent symptoms.