Daily PubMed evidence board
ACR Appropriateness Criteria® Epigastric Pain.
This ACR Appropriateness Criteria guideline summarizes expert-reviewed, evidence-graded recommendations about evaluating people with pain in the upper mid…
Signal score59Research triage score
CertaintyModerateVerify in full text
PMID42246907Source identifier
Research triage, not medical advice
Do not use this summary, score, or benefit-cost estimate to diagnose, treat, prescribe, or change care without reviewing the full study and consulting qualified professionals.
Verify before acting
Check full-text methods, eligibility, outcomes, risk of bias, harms, conflicts, funding, replication, and applicability.
Plain-English signal
This ACR Appropriateness Criteria guideline summarizes expert-reviewed, evidence-graded recommendations about evaluating people with pain in the upper middle part of the belly (epigastric pain). The guideline addresses many possible causes - such as acid reflux (GERD), inflammation of the esophagus or stomach, peptic ulcers, hiatal hernias, and rare but serious problems like perforations - and gives guidance on when imaging and other evaluations are appropriate. The abstract notes that the guideline uses established methods (including adaptations of GRADE and RAND/UCLA approaches) and that expert opinion may be used where studies are lacking.
Why it matters
- Provides multidisciplinary, evidence-graded guidance on imaging and management choices for patients presenting with epigastric pain, a common and diagnostically heterogeneous clinical complaint.
- Covers multiple important causes (GERD, esophagitis, gastritis, peptic ulcer disease, hiatal hernia, and esophageal/gastroduodenal perforation), so recommendations could affect imaging utilization, triage, and diagnosis pathways across emergency, gastroenterology, and radiology settings.
- May influence post-antireflux surgery evaluation and surveillance recommendations, which is relevant for surgical follow-up protocols and imaging resource allocation.
Effect summary
No extractable quantitative effect estimates are provided in the abstract. The document is an evidence-graded guideline synthesizing literature and expert opinion to determine appropriateness of imaging and management in varied epigastric pain scenarios.
Benefit-cost lens
| Quick take | Guideline may change prioritization of imaging or evaluation pathways for epigastric pain, but benefit-cost claims cannot be made from the abstract alone. |
|---|---|
| BCR anchor | 2 |
| Time horizon | 3 |
| Discount rate | 0.03 |
| Assumptions | Assessment based only on PubMed metadata and abstract. Full guideline text may change recommendations, strength of evidence, and scope; verify before operational or policy changes. |
Benefit-cost fields are assumptions-based unless explicitly source-derived. Treat them as prompts for deeper economic review.
Risk of bias
| Tool | rapid-abstract-screen |
|---|---|
| Verdict | Some concerns |
| Notes | Classification as a practice guideline implies systematic review methods, but the abstract does not provide details on search strategy, inclusion criteria, or evidence tables. Recommendation strength and potential conflicts or funding statements are not present in the abstract; a formal risk-of-bias and guideline-assessment (e.g., AGREE II) requires full-text review. |
Harms, equity, conflicts & implementation
| Implementation | Full-text review to extract specific recommendations, recommended imaging modalities and indications, strength of recommendations, required personnel and equipment, workflow changes, and training; local cost and capacity assessment necessary prior to implementation. |
|---|---|
| Equity impact | Unclear from abstract. Equity consequences (differential access to imaging or differential outcomes by subgroup) are not reported and need full-text assessment. |
| Harms | Harms, false positives, radiation exposure tradeoffs, and downstream consequences are not detailed in the abstract; evaluate in full guideline text. |
| Replication | Unknown from automated PubMed triage. |
Source links — verify original
Use PubMed and full-text links to confirm methods, population, outcomes, harms, conflicts, and applicability.