stomach

Nonulcer stomach pain
Introduction
Sometimes, people see their doctors for stomach pain that they think is caused by an ulcer, but it isn't. Although you may have gnawing upper abdominal pain, diagnostic tests don't reveal an ulcer or other digestive problem - all tests come back normal. If this is so, you may have a type of indigestion called nonulcer stomach pain.
Formally, the condition is known as nonulcer dyspepsia (dis-PEP-se-uh). The term "dyspepsia" comes from the Greek roots "dys," meaning "difficult," and "peptein," which means "to digest."

Nonulcer stomach pain is a common, sometimes long-lasting (chronic) disorder of the upper gastrointestinal system, which includes your esophagus and first part of your small intestine (duodenum) as well as your stomach. The disorder can cause signs and symptoms that resemble those of a peptic ulcer, such as pain or discomfort in your upper abdomen, often accompanied by bloating, belching and nausea.
Nonulcer stomach pain occurs for no apparent reason and isn't necessarily related to a particular disease. Rather, the culprit may be a temporary problem, such as eating too quickly, overeating or dealing with a stressful event. For some people, stomach pain is a chronic condition. For many people, however, the symptoms of nonulcer stomach pain are often short-lived and preventable.
Signs and symptoms

The 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
        Gas (flatulence)
        An early feeling of fullness with meals
        Nausea

An unhealthy lifestyle can contribute to nonulcer stomach pain. Stress, fatigue, poor diet, not enough rest, and lack of exercise may aggravate its signs and symptoms.
Causes
The exact cause of nonulcer stomach pain is unknown. In some cases it may occur after a viral infection, but this is rare. Doctors consider it a functional disorder not necessarily related to a specific disease. However, temporary and often aggravating factors can be common causes of the signs and symptoms of nonulcer stomach pain.
Risk factors
Some people naturally are at higher risk of nonulcer stomach pain than others are. Certain lifestyle factors can increase your risk, including:

        Overeating
        Eating too quickly, sometimes with air swallowing
        Drinking carbonated beverages
        Eating spicy foods
        Eating greasy or fatty foods
        Consuming too much caffeine or alcohol
        Smoking
        Taking certain medications, especially nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), and antibiotics
        Stress

When to seek medical advice
Frequent severe indigestion may indicate a more serious disease. See your doctor if you experience any of the following signs or symptoms:

        Persistent or recurrent abdominal pain
        Persistent nausea
        Vomiting, especially if accompanied by blood in your vomit
        Unexplained weight loss
        Persistent loss of appetite
        Bloody stools
        Indigestion accompanied by shortness of breath, sweating, or pain radiating to your chest, neck or arm (possible heart attack)

Be sure to tell your doctor about any worsening signs or symptoms. If you've received a diagnosis of nonulcer dyspepsia, periodic evaluations may assure you and your doctor that no new serious disease has developed.
Screening and diagnosis
To make a diagnosis of nonulcer stomach pain, your doctor first will likely rule out other medical problems that can cause abdominal pain and indigestion, such as:

        An ulcer. An ulcer is an open sore that develops on the inside lining of your stomach, upper small intestine or esophagus.
        Gastroesophageal reflux disease (GERD). This is acondition in which stomach acid backs up into your food pipe (esophagus) causing esophageal irritation or inflammation.
        Gastritis. This is inflammation of the lining of your stomach, which you may experience as a gnawing or burning pain in your stomach or upper abdomen.
        Gastroparesis. This is a disorder in which the stomach takes too long to empty its contents (delayed gastric emptying). Gastroparesis can mimic the symptoms of nonulcer stomach pain and may be associated with other conditions, such as diabetes.
        Gallstones. These solid deposits of cholesterol or calcium salts form in your gallbladder or nearby bile ducts and can cause symptoms such as nausea and an intense, steady ache in the upper middle or upper right abdomen.
        Heart disease. A heart attack or pressure or tightness in your chest caused by restricted blood flow to your heart (angina) can sometimes present as nonulcer stomach pain.
        Diseases of the liver. These may include fatty liver, cirrhosis or liver cancer.
        Diseases of the pancreas. These may include pancreatitis or pancreatic cancer.
        Irritable bowel syndrome (IBS). IBS is characterized by abdominal pain or cramping and changes in bowel function, including bloating, gas, diarrhea and constipation.
        Celiac disease. This condition is triggered by consumption of the protein gluten, which is found in foods that contain wheat, barley, rye or oats.
        Crohn's disease. Crohn's disease is an inflammatory condition that can affect any part of your digestive tract, most often the lower part of the small intestine.

Diagnostic tests
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:

        Laboratory tests. Blood tests may help rule out other diseases that can cause signs and symptoms similar to those of nonulcer stomach pain.
        Barium X-ray or contrast study. For this test, you drink a barium solution. The barium, which shows up on X-rays, coats the inside of your upper digestive tract. Your doctor is then better able to examine your upper gastrointestinal tract and small bowel for the presence of ulcers, tumors, strictures and other abnormalities.
        Endoscopy. 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).
        Ultrasound. Ultrasound imaging uses high-frequency sound waves to create images of your gastrointestinal organs, especially your gallbladder, liver and pancreas. Doctors commonly use this method to look for subtle differences between healthy and unhealthy areas in the organs of the abdomen.
        Gastric emptying study. In this study, you eat a meal that contains a small amount of radiation. A radiologist then measures how long it takes food to leave your stomach.

Complications
Because nonulcer stomach pain is a disorder unrelated to disease, it doesn't lead to more-serious conditions. However, complications may include:

        Problems caused by tests done to rule out other disorders
        Side effects of medications taken to treat the condition
        Worry about having other conditions

Treatment
For most people, treating indigestion primarily focuses on preventing recurrence and on self-care. For others, nonulcer stomach pain tends to be a long-lasting (chronic) or recurrent condition requiring medical treatment. Treatment options include:
Medications
Several types of medications are available for managing the signs and symptoms of nonulcer stomach pain. These may include:

        Antacids. Multi-ingredient 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.
        Acid blockers. Drugs such as cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid) and famotidine (Pepcid) decrease the amount of acid your stomach produces.
        Proton pump inhibitors. These types of medications shut down the acid "pumps" within acid-secreting stomach cells. Proton pump inhibitors reduce acid by blocking the action of these tiny pumps. They include the prescription medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and esomeprazole (Nexium). A similar drug, pantoprazole (Protonix), can be taken orally or intravenously.
        Prokinetic agents. These drugs 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.
        Antispasmodics. These drugs relax the smooth muscles in your intestines, working to decrease indigestion. Commonly prescribed medications include dicyclomine (Bentyl, Dibent) and hyoscyamine (Levsin, Cystospaz).
        Acid suppressors (cytoprotective agents). These medications are designed to help protect the tissues that line your stomach and small intestine. They include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec). If you're taking NSAIDs regularly, your doctor may suggest that you also take one of these medications to protect your stomach. Another cytoprotective agent is bismuth subsalicylate (Pepto-Bismol).
        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 the role of the intestines in decreasing pain. Your doctor may suggest antidepressants such as imipramine (Tofranil) and amitriptyline. SSRIs such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil) also may be helpful.
        Antibiotic treatment for Helicobacter pylori (H. pylori) infection. Tests may indicate that these common ulcer-causing bacteria are present in your stomach, though you have no ulcer. Treatment for H. pylori infection is with antibiotics, sometimes given in combination with a proton pump inhibitor. Antibiotics most commonly prescribed for treatment of H. pylori include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl) and tetracycline (Sumycin). Some pharmaceutical companies package a combination of two antibiotics together, with an acid suppressor or cytoprotective agent, specifically for treatment of H. pylori infection. These combination treatments are sold under the brand names Prevpac and Helidac. Although antibiotics are often prescribed for H. pylori, it's not clear whether treatment with antibiotics for those with the infection but no ulcers will decrease symptoms. Discuss the risks and benefits of antibiotic treatment with your doctor.

Behavior therapy
This type of treatment focuses on changing unwanted or unhealthy behaviors, typically using a system of rewards and reinforcements of positive behavior. In the case of nonulcer dyspepsia, for instance, if you tend to overeat or eat too quickly, often causing you indigestion, you might be trained in ways to stop such habits, therefore reducing your risk of abdominal discomfort.
Prevention
Maintaining a healthy lifestyle can often prevent nonulcer stomach pain. The following lifestyle modifications may help alleviate your signs and symptoms:
Diet

        Eat smaller, more frequent meals. Having an empty stomach can sometimes produce signs and symptoms similar to those of nonulcer dyspepsia. 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 the signs and symptoms of nonulcer stomach pain, such as fatty and spicy foods, carbonated beverages, caffeine and alcohol. Avoid consuming more than three caffeinated beverages a day.
        Chew your food slowly and thoroughly. Allow time for leisurely meals.
        Limit beverages during meals. If you feel full early on during the meal, restrict your intake of beverages.
        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 and drinking carbonated beverages.
        Don't lie down right after a meal. Wait to lie down until at least two hours after eating.
        Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.

Stress

        Create a calm environment at mealtime. This may help relieve stress-related indigestion.
        Identify current stressors in your life. Learn how to manage your stress by exercising and listening to soothing music.
        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.

Fatigue

        Find the right mix. Balance your rest and activity.
        Try to have a bedtime routine. When possible, go to bed and get up at the same times each day.
        Sleep only as much as you need. Get enough sleep so that you feel refreshed, but avoid getting too much sleep.
        Take time each day to relax. Find a few minutes just for you.
        Pace yourself. Don't try doing too much at one time.

Exercise

        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.

Stress

        Create a calm environment at mealtime. This may help relieve stress-related indigestion.
        Identify current stressors in your life. Learn how to manage your stress by exercising and listening to soothing music.
        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.

Fatigue

Exercise

Coping skills
Living with nonulcer stomach pain can be challenging. In addition to dealing with frequent abdominal discomfort, other areas of your life also may be affected. Ultimately, your condition may interfere with your interaction with friends and family, your productivity at work, and the overall quality of your life. Talk to your friends and family about your condition. Socializing is often centered on food, and the understanding and support of those around you can help you better cope with the effects of nonulcer stomach pain and your efforts to prevent it.