Almost everyone has had a stomach ache at some point. Most of the time it passes — something you ate, stress, a minor infection. We deal with it, move on, and forget it ever happened.
But what about the persistent stomach pain that keeps coming back? The discomfort that has been there, on and off, for weeks or months? The stomach that never quite feels right?
In Nigeria, persistent abdominal pain is one of the most common reasons people eventually see a doctor — often after months of managing the symptoms themselves with over-the-counter medications. And while many causes are benign and manageable, some are serious conditions that worsen significantly when left undiagnosed.
This article explains what different types of abdominal pain can mean, the warning signs you should not ignore, and when it is time to stop managing and start investigating.
Location Matters: What the Position of Your Persistent Stomach Pain Tells You
The abdomen is divided into regions, and the location of your pain is one of the most useful clues about what might be causing it. While it is not a definitive diagnosis — many conditions can cause pain in multiple areas — it provides a useful starting point.
Upper Middle Abdomen (Epigastric Region)
Pain in the upper centre of the abdomen — the area between your chest and navel — is often related to the stomach, duodenum, or oesophagus. Common causes include peptic ulcer disease (stomach or duodenal ulcers), gastritis (inflammation of the stomach lining), acid reflux (GORD), and gastro-oesophageal disease. This is also where pancreatic pain is often felt, typically as a deep, boring discomfort that may radiate to the back.
Upper Right Abdomen
Persistent Stomach Pain under the right rib cage is classically associated with the liver, gallbladder, and bile ducts. Gallstone disease, cholecystitis (gallbladder inflammation), liver disease, and bile duct obstruction all tend to cause pain in this region. The pain may be dull and persistent or come in sharp, intense waves — particularly after eating fatty foods.
Upper Left Abdomen
The upper left abdomen houses the spleen, part of the stomach, and the left side of the colon. Pain here may be related to gastric conditions, splenic enlargement (splenomegaly — common in malaria and some blood disorders in Nigeria), or colonic disease.
Lower Abdomen
The lower abdomen houses the large intestine, bladder, and (in women) the reproductive organs. Lower abdominal pain can be related to conditions such as irritable bowel syndrome, inflammatory bowel disease, diverticular disease, urinary tract infection, or gynaecological conditions.
Central/Diffuse Abdominal Pain
Pain that is difficult to localise — spread across the whole abdomen or felt in the centre — can indicate conditions such as irritable bowel syndrome, early appendicitis (which often begins around the navel before moving to the right), bowel obstruction, or mesenteric ischaemia (reduced blood supply to the bowel).
Common Causes of Persistent Abdominal Pain in Nigeria
Peptic Ulcer Disease
Peptic ulcers are one of the most common causes of recurrent upper abdominal pain in Nigeria. They develop when the protective lining of the stomach or duodenum is eroded — most commonly due to Helicobacter pylori (H. pylori) bacterial infection or long-term use of non-steroidal anti-inflammatory drugs (NSAIDs). The pain is typically described as a burning or gnawing discomfort in the upper centre of the abdomen, which may be worse when the stomach is empty and better after eating.
Gastritis
Inflammation of the stomach lining (gastritis) can cause persistent upper abdominal discomfort, nausea, bloating, and a feeling of fullness after small amounts of food. It has many causes including H. pylori infection, excessive alcohol, stress, and NSAIDs.
Gastro-Oesophageal Reflux Disease (GORD)
Acid reflux causes a burning sensation in the chest and upper abdomen, often worsening after meals or when lying down. Chronic reflux can cause significant discomfort and — if untreated over years — lead to more serious changes in the oesophageal lining.
Gallstone Disease
As discussed above, gallstones cause recurrent pain in the upper right abdomen, often after eating fatty food. This is a common and important cause of persistent abdominal symptoms that is frequently under-diagnosed.
Irritable Bowel Syndrome (IBS)
IBS is a functional disorder of the bowel that causes chronic abdominal pain or discomfort, typically associated with changes in bowel habit (diarrhoea, constipation, or alternating between the two) and bloating. It is very common but does not cause any structural damage to the bowel.
Inflammatory Bowel Disease (IBD)
Crohn’s disease and ulcerative colitis are chronic inflammatory conditions that can cause persistent abdominal pain, diarrhoea (sometimes with blood), weight loss, and fatigue. They require specialist management and can have serious complications if untreated.
Red Flag Symptoms: When to Seek Urgent Attention
The following symptoms — particularly when occurring alongside or instead of persistent abdominal pain — are warning signs that require prompt medical evaluation. Do not wait these out:
- Unintentional weight loss
- Blood in the stool — whether bright red, dark, or black and tarry
- Difficulty swallowing
- Persistent vomiting, or vomiting blood
- Jaundice (yellowing of skin or eyes)
- A palpable mass or lump in the abdomen
- Fever alongside abdominal pain
- Severe pain that comes on suddenly — especially if the abdomen becomes hard or rigid
The Role of Upper Endoscopy in Diagnosing Abdominal Pain
When upper abdominal pain persists and does not respond to standard treatment, or when red flag symptoms are present, an upper endoscopy (gastroscopy) is usually one of the key investigations.
Upper endoscopy allows a gastroenterologist to directly examine the lining of the oesophagus, stomach, and duodenum using a thin, flexible camera. It can identify ulcers, gastritis, H. pylori infection, Barrett’s oesophagus, and early cancers that cannot be seen on an ultrasound or CT scan. Biopsies can be taken during the same procedure to confirm a diagnosis.
If you have been experiencing persistent upper abdominal pain — particularly if it has been going on for more than a few weeks, is worsening, or is accompanied by any of the red flag symptoms above — an upper endoscopy may give you the answers you need.
At Redus Center for Digestive Health in Lekki, Lagos, our specialists perform upper endoscopy with high-definition equipment in a comfortable, sedated setting. Many patients are surprised at how straightforward the experience is.
Frequently Asked Questions
How long is too long to have abdominal pain before seeing a doctor?
Any abdominal pain that has persisted for more than two weeks without a clear explanation, or that keeps returning, warrants a medical assessment. Do not wait for red flag symptoms to appear — earlier investigation leads to earlier diagnosis and better outcomes.
Can stress really cause abdominal pain?
Absolutely. The gut and brain are closely connected through what is called the gut-brain axis. Psychological stress is a well-established trigger for both IBS and peptic ulcer disease. However, stress being a contributing factor does not mean nothing else is going on — a proper assessment is still important.
I have been treating my stomach pain as ulcer for years. Could it be something else?
Quite possibly. Peptic ulcer disease is common in Nigeria, but many other conditions — including gallstone disease, gastritis, GORD, and in less common cases, stomach cancer — can cause similar symptoms. If you have been self-medicating without a confirmed diagnosis, it is worth seeing a gastroenterologist for a proper assessment.
Is an upper endoscopy the only way to diagnose stomach problems?
Not the only way, but often the most definitive. Ultrasound can detect gallstones and liver problems. Blood tests can screen for H. pylori and liver disease. CT scans can detect masses. But for directly examining the mucosal lining of the oesophagus, stomach, and duodenum — and taking biopsies — upper endoscopy cannot be matched.
| Tired of living with recurring abdominal pain? Get a proper diagnosis. Book a consultation at Redus Center for Digestive Health, Lekki Phase 1, Lagos. Call +234 704 084 7895 or visit redushealth.com. |