Nonulcer stomach pain

Definition

Nonulcer stomach pain is a term used to describe signs and symptoms of indigestion that have no obvious cause. Nonulcer stomach pain is also called functional dyspepsia (dis-PEP-see-uh) or nonulcer dyspepsia.

Nonulcer stomach pain is common and can be long lasting. Nonulcer stomach pain can cause signs and symptoms that resemble those of an ulcer, such as pain or discomfort in your upper abdomen, often accompanied by bloating, belching and nausea.

Symptoms

Signs and symptoms of nonulcer stomach pain may include:

• A burning sensation or discomfort in your upper abdomen or lower chest, sometimes relieved by food or antacids
• Bloating
• Belching
• An early feeling of fullness when eating
• Nausea

When to see a doctor
Make an appointment with your doctor if you experience persistent signs and symptoms that worry you.

Seek immediate medical attention if you experience:

• Bloody vomit
• Dark, tarry stools
• Shortness of breath
• Pain that radiates to your jaw, neck or arm

Causes

Many times, it's not clear what causes nonulcer stomach pain. Doctors consider it a functional disorder, which means it's not necessarily caused by a specific disease.

Risk factors

Factors that can increase the risk of nonulcer stomach pain include:

• Consuming excessive amounts of caffeine or alcohol
• Smoking
• Taking certain medications, especially nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), which can cause stomach problems

Preparing for your appointment

Make an appointment with your family doctor or a general practitioner if you have signs or symptoms that worry you. If nonulcer stomach pain is suspected, your doctor may refer you to a specialist in digestive diseases (gastroenterologist).

How to prepare
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. To prepare for your appointment, try to:

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Questions to ask
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For nonulcer stomach pain, some basic questions to ask your doctor include:

• What is likely causing my stomach pain?
• What are other possible causes for my stomach pain?
• What kinds of tests do I need?
• Is my stomach pain likely temporary or chronic?
• What are my treatment options?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic version of the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

Tests and diagnosis

Your doctor will likely review your signs and symptoms and perform a physical examination. A number of diagnostic tests may help your doctor determine the cause of your discomfort. These may include:

• Blood tests. Blood tests may help rule out other diseases that can cause signs and symptoms similar to those of nonulcer stomach pain.
• Stool tests. Your doctor may test a sample of your stool to look for a bacterium called Helicobacter pylori (H. pylori) that can cause stomach problems.
• Using a scope to examine your digestive system. A thin, flexible, lighted instrument (endoscope) is passed down your throat so that your doctor can view your esophagus, stomach and the first part of your small intestine (duodenum).

Treatments and drugs

Nonulcer stomach pain that is long lasting and isn't controlled by lifestyle changes may require treatment. What treatment you receive depends on your signs and symptoms. Treatment may combine medications with behavior therapy.

Medications
Medications that may help in managing the signs and symptoms of nonulcer stomach pain include:

• Over-the-counter antacids. Antacids (Maalox, Mylanta, others) in liquid or tablet form are a common treatment for indigestion. Antacids neutralize stomach acid and can provide fast pain relief.
• Over-the-counter gas remedies. Drugs that contain the ingredient simethicone may provide some relief by reducing gas. Examples of gas-relieving remedies include Mylanta and Gas-X.
• Medications to reduce acid production. Called H-2-receptor blockers, these medications are available over-the-counter and include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac 75). Stronger versions of these medications are available in prescription form.
• Medications that block acid 'pumps.' Proton pump inhibitors shut down the acid "pumps" within acid-secreting stomach cells. Proton pump inhibitors reduce acid by blocking the action of these tiny pumps. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC). Stronger, prescription proton pump inhibitors also are available.
• Medication to strengthen the esophageal sphincter. Prokinetic agents help your stomach empty more rapidly and may help tighten the valve between your stomach and esophagus, reducing the likelihood of upper abdominal discomfort. Doctors may prescribe the medication metoclopramide (Reglan), but this drug may have significant side effects.
• Medications that control muscle spasms. Antispasmodic medications may help relieve stomach pain that's caused by spasms in the intestinal muscles. These medications include dicyclomine (Bentyl) and hyoscyamine (Levsin).
• Low-dose antidepressants. Tricyclic antidepressants and drugs known as selective serotonin reuptake inhibitors (SSRIs), taken in low doses, may help inhibit the activity of neurons that control intestinal pain. Your doctor may suggest antidepressants such as nortriptyline (Pamelor) and desipramine (Norpramin). SSRIs such as sertraline (Zoloft) or escitalopram (Lexapro) also may be helpful.
• Antibiotics. If tests indicate that a common ulcer-causing bacterium called H. pylori is present in your stomach, your doctor may recommend antibiotics. Antibiotics may also be used if tests reveal you have too much bacteria in your intestines.

Behavior therapy
Working with a counselor or therapist may help relieve signs and symptoms that aren't helped by medications. A counselor or therapist can teach you relaxation techniques that may help you cope with your signs and symptoms. You may also learn ways to reduce stress in your life in order to prevent nonulcer stomach pain from recurring.

Lifestyle and home remedies

Your doctor may recommend lifestyle changes to help you control your nonulcer stomach pain.

Make changes to your diet
Changes to your diet and how you eat might help control your signs and symptoms. Consider trying to:

• Eat smaller, more-frequent meals. Having an empty stomach can sometimes produce nonulcer stomach pain. Nothing but acid in your stomach may make you feel sick. Try eating a small snack, such as a cracker or a piece of fruit. Avoid skipping meals. Avoid large meals and overeating. Eat smaller meals more frequently.
• Avoid trigger foods. Some foods may trigger nonulcer stomach pain, such as fatty and spicy foods, carbonated beverages, caffeine and alcohol.
• Chew your food slowly and thoroughly. Allow time for leisurely meals.
• Take steps to avoid excessive air. To reduce excess gas and belching, refrain from activities that result in excessive air swallowing, such as smoking, eating rapidly, chewing gum, drinking through a straw and drinking carbonated beverages.
• Stay upright after a meal. Wait to lie down until at least two hours after eating.

Reduce stress in your daily life
Stress-reduction techniques may help you control your signs and symptoms. To reduce stress, try to:

• Identify current stressors in your life. Learn how to manage your stress. Exercising, if your doctor confirms that it's safe for you, and listening to soothing music may help.
• Learn and practice relaxation techniques. These may include relaxed breathing, meditation, yoga and progressive muscle relaxation.
• Pursue relaxing activities. Spend time doing things you enjoy, such as hobbies or sports.

Exercise most days of the week
Exercise may help you control your signs and symptoms. As you get started, try to:

• Talk to your doctor. Get your doctor's advice before beginning a new exercise routine.
• Take it easy at first. Start your exercise program gradually.
• Get regular physical activity. Aim for at least 30 to 60 minutes of physical activity on most days of the week to achieve and maintain a healthy weight and reduce your risk of many chronic diseases.
• Don't exercise immediately after eating. Give your stomach time to settle.

Alternative medicine

People with nonulcer stomach pain often turn to complementary and alternative medicine to help them cope. No complementary or alternative treatments are proven to cure nonulcer stomach pain. But when used along with your doctor's care, complementary and alternative treatments may provide relief from your signs and symptoms.

If you're interested in complementary and alternative treatments, talk to your doctor about:

• Herbal supplements. Herbal remedies that have shown some benefit for nonulcer stomach pain include peppermint and caraway oil.
• Hypnosis. Hypnosis is a deep state of concentration that you can achieve by working with a therapist. Some evidence suggests hypnotherapy treatment may help relieve the signs and symptoms of nonulcer stomach pain.
• Relaxation techniques. Activities that help you relax may help you control and cope with your signs and symptoms. Consider trying meditation, yoga or other activities that may help reduce your stress levels.