ACR Appropriateness Criteria Epigastric Pain

J Am Coll Radiol. 2026 Jun 5:S1546-1440(26)00234-6. doi: 10.1016/j.jacr.2026.05.003. Online ahead of print.

ABSTRACT

Many different pathologies can present with epigastric pain, and the overlap of the symptoms of these varying entities can make diagnosis difficult clinically. This document focuses on scenarios including esophageal and gastroduodenal perforations, those occurring after post reflux surgeries and procedures, gastroesophageal reflux disease (GERD), esophagitis, gastritis, peptic ulcer disease, and hiatal hernias. Also included is recurrent GERD and hiatal hernia post reflux procedures and surgeries. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

PMID:42246907 | DOI:10.1016/j.jacr.2026.05.003