”Gastroscopy showed normal, why do I still have stomach pain?” This situation is often seen in clinical practice, so why does this phenomenon occur? In fact, the reason is very simple, first of all, gastroscopy can only diagnose organic diseases of the stomach, it cannot diagnose functional gastric diseases, and at the same time, the cause of stomach pain is not always stomach disease. What diseases can be diagnosed by gastroscopy? Gastroscopy can see the esophagus, cardia, the entire stomach, the pylorus, and the descending part of the duodenum. As long as the diseases of the esophagus, stomach, and organic diseases above the descending part of the duodenum, such as esophagitis, gastritis, duodenal ballooning or ulcers, polyps, and cancer, can be detected by gastroscopy, and pathological biopsy can be done through gastroscopy to clarify the nature of the lesions. Can functional gastroparesis cause stomach pain Functional gastroparesis, especially functional dyspepsia, is one of the most common causes of stomach pain, and some data show that the prevalence of functional dyspepsia in the domestic population is about 20%, with about 300 million people. Functional dyspepsia is a group of clinical syndromes with various clinical manifestations, mainly epigastric pain, epigastric distention, early satiety, belching, loss of appetite, nausea and vomiting. It can appear alone or as a group of symptoms. The symptoms may change during the course of the disease, and the onset of the disease is slow, persistent or recurrent, and many patients have diet and mental triggers. Although patients with functional dyspepsia may have symptoms such as abdominal pain, bloating, nausea, vomiting, etc., but there are no obvious abnormal changes through gastroscopy or only mild mucosal congestion and edema, which is typical of functional diseases. These diseases are mostly related to mental and psychological factors. Although the symptoms are obvious and the medical history is long, they generally do not affect the patient’s general condition and have a good prognosis. What other diseases can cause “stomach pain”? 1, liver and biliary system diseases: common like gallstones, cholecystitis, due to the stimulation of gallstones, the gallbladder and bile ducts can have different degrees of inflammation. Patients mostly have irregular vague pain and discomfort in the heart fossa (or under the right rib cage), and sometimes symptoms similar to stomach diseases such as upper abdominal fullness and belching can occur. Other symptoms such as hepatocellular carcinoma and common bile duct carcinoma can be manifested as “stomach pain” and symptoms such as upper abdominal fullness, weakness, poor appetite and jaundice, which can be easily misdiagnosed as stomach disease. 2, pancreatic disease: The initial stage of acute pancreatitis is also manifested as pain in the upper middle abdomen, persistently increasing, accompanied by nausea and vomiting, and some patients have pain radiating to the lower back. The symptoms are very much like “stomach pain” at this time, but the pain lasts longer and has a tendency to increase in paroxysms. The first symptom of pancreatic cancer is abdominal pain or upper abdominal fullness and discomfort. Patients who visit the clinic because of abdominal pain, jaundice, upper abdominal discomfort, digestive discomfort, emaciation, nausea, vomiting, diarrhea or sudden onset of diabetes should consider the possibility of pancreatic cancer. 3.Acute appendicitis: Typical acute appendicitis initially has pain in the middle and upper abdomen or around the umbilicus, and after a few hours the abdominal pain shifts and is fixed in the right lower abdomen. The early stage is a kind of visceral nerve reflex pain, so the pain in the middle and upper abdomen and around the umbilicus is more diffuse and often cannot be located exactly. When the inflammation spreads to the plasma membrane layer and wall peritoneum, the pain is fixed in the right lower abdomen, and the original pain in the middle and upper abdomen or around the umbilicus is reduced or disappears. 4, myocardial infarction: the elderly may not always have anterior precordial angina in heart attack, but may only complain of “stomach pain” or discomfort in the heart fossa, accompanied by nausea and vomiting, so blindly treated as stomach disease, it is easy to misdiagnose. 5, cervical gastric syndrome: When osteophytes occur in the cervical spine, the proliferating bone spurs, degenerated discs and narrowed intervertebral spaces can produce adverse stimulation to the sympathetic nerves, which are abundantly distributed in the neck. These strong stimulation signals can inhibit gastrointestinal secretion and peristalsis, resulting in a series of symptoms resembling gastric disease such as dry mouth, lack of food and drink, abdominal distension, burping and belching, vague pain in the upper abdomen and even nausea and vomiting. So a normal gastroscopy does not mean that there is no stomach disease, and having stomach pain is not always caused by stomach disease.