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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:

  • Drinking too much alcohol or too many caffeinated beverages
  • Smoking
  • Taking certain medications, especially certain over-the-counter pain relievers, such as aspirin and ibuprofen (Advil, Motrin IB, 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).

What you can do

Take these steps to prepare for your appointment:

  • 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.
  • Note down any symptoms you're experiencing, even if they seem unrelated to the reason you have scheduled the appointment.
  • Make a note of key personal information, including things like recent life changes, or major stresses.
  • 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 a list of questions to ask your doctor.

Questions to ask your doctor

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 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

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).
Endoscopy

An endoscopy procedure involves inserting a long, flexible tube (endoscope) down your throat and into your esophagus. This test is usually done under sedation. A tiny camera on the end of the endoscope lets your doctor examine your esophagus, stomach and the beginning of your small intestine (duodenum). A small tissue sample (biopsy) is usually taken for analysis.

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 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.

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 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, spend time doing things that you enjoy, such as hobbies or sports. Relaxation therapy or yoga also may help.

Alternative medicine

People with nonulcer stomach pain often turn to complementary and alternative medicine to help them cope. No complementary or alternative treatments are proved 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 a combination of peppermint and caraway oil. These supplements may relieve some of the symptoms of nonulcer stomach pain, such as fullness and gastrointestinal spasms.

    Artichoke leaf extract may also reduce symptoms of nonulcer stomach pain, including vomiting, nausea and abdominal 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.

Last updated: February 6th, 2015

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