Pain in the middle of the epigastrium may be due to gastritis, duodenal ulcer, gastric perforation and other diseases. 1. Gastritis: acute gastritis is usually due to alcohol, trauma, stress and other conditions, while chronic gastritis may be due to Helicobacter pylori infection, autoimmune mechanism caused by gastric mucosal damage. Generally acute gastritis patients often appear epigastric pain, nausea, vomiting and other symptoms, some patients can also be manifested as epigastric pain in the middle. Severe symptoms can also be accompanied by vomiting blood, dehydration, black stools, shock and so on. 2. Duodenal ulcer: usually due to stomach acid, heredity, Helicobacter pylori infection, drugs and other conditions, and also with long-term smoking and drinking, long-term mental stress and other factors. Patients often appear epigastric pain symptoms, and can also be presented as cyclical, rhythmic, but also manifested as dull pain, burning pain, distension, etc., can also appear in the middle of the epigastric pain. 3. Gastric perforation: usually due to gastric ulcer, and also related to gastric cancer, drugs, trauma, etc., and overeating, acute stress and other factors, can aggravate gastric ulcer, thus inducing gastric perforation. In addition, myocardial infarction can also be manifested as epigastric pain in the middle, for middle-aged and elderly patients, cardiovascular and cerebrovascular risk factors should be taken seriously. It is recommended that patients with symptoms of epigastric pain in the middle of the abdomen, the symptoms continue without relief or progressive aggravation, should go to the hospital in a timely manner, to clarify the cause and active treatment.