[Experiences with the "epigastric pain syndrome"]

The report concerns 162 patients suffering from severe upper abdominal pain without organic findings on routine GI-exploration. Palpation of the abdominal wall revealed well localised pain maxima which appeared to correlate with the distribution of intercostal nerve endings. Exploratory local anaesthesia was able to relieve these symptoms whereby - much to our surprise - the therapeutic effect very often outlasted by months and even years the pharmacological effect attributable to the anaesthetic agent. 129 of the 162 patients treated could be significantly improved or even freed of their painful symptoms. Out of the 33 patients with recurring symptoms, three quarters could be cured or significantly improved by separating the subcutaneous fat from the epigastric fascia, thus destroying the cutaneous branches of the intercostal nerves. It seems legitimate to consider the pathogenesis of these symptoms as being due to entrapments of the intercostal nerve endings in the abdominal fascia and it may thus be considered as an organic entity. Diagnosis is relatively easy and without risk for the patient: exploratory local anaesthesia loco dolenti, which in fact may have a long lasting therapeutic effect.