A single copy of this article may be reprinted for personal, noncommercial use only.
Nonulcer stomach painBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/stomach-pain/DS00524
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.
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
- An early feeling of fullness when eating
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
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.
Factors that can increase the risk of nonulcer stomach pain include:
- Consuming excessive amounts of caffeine or alcohol
- Taking certain medications, especially certain over-the-counter pain relievers, 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. To prepare, try to:
- Be aware of any pre-appointment restrictions. At the time you make the appointment, 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.
- Consider taking a family member or friend along. Sometimes it can be difficult to remember 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 can 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 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 brochures or other printed material that I can take with me? What websites 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 other questions that occur to you during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Have you lost weight?
Tests and diagnosis
CLICK TO ENLARGE
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.
- Tests for a bacterium. Your doctor may recommend a test to look for a bacterium called Helicobacter pylori (H. pylori) that can cause stomach problems. H. pylori testing may use your blood, stool or breath.
- 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 that may help in managing the signs and symptoms of nonulcer stomach pain include:
- 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 24HR) and omeprazole (Prilosec OTC). Stronger proton pump inhibitors also are available by prescription.
- 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 doesn't work for everyone and may have significant side effects.
- 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.
- Antibiotics. If tests indicate that a common ulcer-causing bacterium called H. pylori is present in your stomach, your doctor may recommend antibiotics.
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.
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, plan 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.
- Avoid exercising immediately after eating. Give your stomach time to settle.
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 may be of some benefit for nonulcer stomach pain include peppermint and caraway oil. These supplements haven't been proved to cure nonulcer stomach pain.
- Hypnosis. Hypnosis is a deep state of concentration that you can achieve by working with a therapist. If other treatment hasn't helped, 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.
- Borkan J, et al. Dyspepsia, nonulcerative. In: Ferri FF. Ferri's Clinical Advisor 2012: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-323-05611-3..C2009-0-38601-8--TOP&isbn=978-0-323-05611-3&uniqId=287085263-2. Accessed Oct. 17, 2011.
- Tack J. Dyspepsia. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4160-6189-2..X0001-7--TOP&isbn=978-1-4160-6189-2&about=true&uniqId=229935664-2192. Accessed Oct. 17, 2011.
- Indigestion. National Institute for Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/indigestion/index.aspx. Accessed Oct. 17, 2011.
- Loyd RA, et al. Update on the evaluation and management of functional dyspepsia. American Family Physician. 2011;83:547.