Patient information: Upset stomach (functional dyspepsia) in adults

INTRODUCTION

Functional dyspepsia is the medical term for a condition that causes an upset stomach or pain or discomfort in the upper belly, near the ribs. Functional dyspepsia often comes back over time. It can develop because of an underlying medical problem. However, doctors are not able to find a cause for functional dyspepsia in most people.

This article discusses the symptoms, testing, and treatment options for people with functional dyspepsia. Chronic abdominal pain in children and adolescents is discussed separately (see "Patient information: Chronic abdominal pain in children and adolescents").

More detailed information about dyspepsia is available by subscription. (See "Functional dyspepsia" and "Approach to the patient with dyspepsia".)

FUNCTIONAL DYSPEPSIA SYMPTOMS

The most common symptoms of functional dyspepsia include:

• Upset stomach
• Discomfort or pain in the belly
• Bloating
• Feeling full quickly when eating

Some people also have nausea, vomiting, a lack of appetite, or weight loss.

When to seek help — If you have any of the following, call your doctor or nurse:

• Vomiting that will not stop
• Vomiting blood
• If you are losing weight or have no appetite
• Bloody or dark-colored, tarry bowel movements
• Pain or difficulty with swallowing

FUNCTIONAL DYSPEPSIA CAUSES

It is usually not clear what causes functional dyspepsia. However, researchers have focused on several factors that may be involved.

Motor or nerve problems — The process of digesting food involves a series of events involving the nerves and muscles of the digestive tract. Problems in this system can cause the stomach to empty more slowly than normal, causing nausea and vomiting, feeling full quickly when eating, or bloating. However, not everyone whose stomach empties slowly has functional dyspepsia.

Pain sensitivity — The stomach normally stretches as we eat to hold more food. However, some people are sensitive to this stretching and feel pain. It is not clear why this happens.

Infection — Helicobacter pylori (H. pylori) is a bacterial infection of the stomach that can lead to inflammation (gastritis) or ulcers. There may be a relationship between infection with H. pylori and functional dyspepsia. However, not all people with H. pylori have functional dyspepsia. (See "Patient information: Helicobacter pylori infection and treatment".)

Psychological and social factors — People with functional dyspepsia often have mood problems, like anxiety or depression. Treating the underlying depression or anxiety can improve symptoms of abdominal pain.

FUNCTIONAL DYSPEPSIA DIAGNOSIS

To help figure out the cause of your symptoms, your doctor or nurse will ask you questions and perform a physical exam. Questions to think about before your visit include:

• Is the pain "gnawing" or worse when you are hungry?
• Is the pain worse when you move in certain ways or press on certain areas of the abdomen?
• Do you take medicines for pain, such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve)? Do you have a history of ulcers?
• Do you also have heartburn?
• Do you have intense pain in the upper right or middle of the abdomen? Does the pain shoot into your back or between the shoulder blades? Does this happen periodically, along with vomiting, sweating, or feeling restless?
• Have there been changes in your bowel movements (new constipation or diarrhea)?
• Have you recently unintentionally lost weight, vomited repeatedly, or had difficulty swallowing?

Testing recommendations — The best way to diagnose functional dyspepsia is not clear. One expert group recommends the following:

• If you are older than 55 or have serious symptoms, such as repeated vomiting, weight loss, or difficulty swallowing, you might need an upper endoscopy procedure. This is a test that allows your doctor to look inside your esophagus, stomach, and upper intestine. (See "Patient information: Upper endoscopy".)
• If you are younger than 55 or you do not have serious symptoms, you might be offered other types of testing. This might include a breath or stool test for H. pylori. (See "Patient information: Helicobacter pylori infection and treatment".)

If your symptoms do not get better within four to eight weeks or if you get worse, your doctor or nurse might recommend further testing, including upper endoscopy.

FUNCTIONAL DYSPEPSIA TREATMENT

Understand the condition — Being diagnosed with functional dyspepsia might be a relief to some people and a frustration to others. It is important to understand that your pain is not in your head. If you have questions or concerns about your symptoms or treatments that are offered, talk to your doctor or nurse honestly.

If you have mood problems, such as anxiety or depression, your doctor or nurse might recommend that you see a mental health specialist (eg, social worker, psychologist, counselor). Dealing with emotional issues can help you to feel better, both physically and mentally.

Diet — Some people feel less pain after making changes in what they eat. This might include:

• Avoiding fatty foods (which can slow the emptying of the stomach)
• Eating small, frequent meals. Instead of three large meals, eat five or six small meals.
• Avoiding foods that make you feel worse. However, do not stop eating whole food groups unless you talk to your doctor or nurse.

If you have questions about what you should eat, talk to your doctor, nurse, or a dietitian.

Acid-reducing medicines — Some people feel better after taking a medicine that reduces stomach acid. Examples include:

• Proton pump inhibitors (PPIs) are more likely than other types of acid reducers to improve pain. Example of PPIs include omeprazole (Prilosec®), esomeprazole (Nexium®), lansoprazole (Prevacid®), dexlansoprazole (Kapidex®), pantoprazole (Protonix®), and rabeprazole (Aciphex®).
• Histamine blockers do not work as well as PPIs but might help some people. Examples include ranitidine (Zantac®), famotidine (Pepcid®), cimetidine (Tagamet®), and nizatidine (Axid®).
• Antacids are not usually helpful for people with functional dyspepsia. Examples of antacids include Tums®, Maalox®, and Mylanta®.

H. pylori treatment — If you are diagnosed with H. pylori and you have a stomach ulcer, treating the H. pylori can help to reduce symptoms of functional dyspepsia. (See "Patient information: Helicobacter pylori infection and treatment".)

If you test positive for H. pylori but you do not have a stomach ulcer, talk to your doctor or nurse to see if you should be treated. In this case, treating H. pylori usually does not help to reduce symptoms of indigestion.

Pain medicines — Low doses of an antidepressant medicine might help to reduce symptoms, even if you are not depressed. One of the most commonly used antidepressants is called a tricyclic antidepressant (TCA). It is not clear how TCAs work, but they seem to improve pain when taken at low doses. The dose of TCAs used to treat pain is usually much lower than that used to treat depression.

TCAs commonly used for pain include amitriptyline and desipramine. In the beginning, many people who take TCAs feel tired; this is not always an undesirable side effect since it can help improve sleep when TCAs are taken in the evening. TCAs are generally started in low doses and increased gradually. It can take a few weeks to begin feeling better.

Nonprescription pain medicines like aspirin, ibuprofen (sold as Advil®, Motrin®), and naproxen (sold as Aleve®) are not usually helpful and can actually worsen stomach upset.

Prescription pain medicines, such as codeine, hydrocodone, or oxycodone, are not usually recommended long-term. These medicines have side effects (constipation) and are addictive.

Complementary and alternative medicine — Several complementary and alternative medicine treatments are advertised to improve functional dyspepsia. Examples include treatments that include peppermint and caraway. However, there are not good studies of these treatments, so it is not clear if they are safe or if they work. For reliable information about complementary and alternative treatments, see the National Institutes of Health Web site at www.nccam.nih.gov.

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed every four months on our Web site (www.uptodate.com/patients).

Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information

Patient information: Chronic abdominal pain in children and adolescents
Patient information: Helicobacter pylori infection and treatment
Patient information: Upper endoscopy

Professional level information

Approach to the patient with dyspepsia
Chronic abdominal wall pain
Diagnostic approach to abdominal pain in adults
Differential diagnosis of abdominal pain in adults
Functional dyspepsia
History and physical examination in adults with abdominal pain

The following organizations also provide reliable health information:

• National Library of Medicine

      (www.nlm.nih.gov/medlineplus/ency/article/003260.htm)

• National Institute of Diabetes and Digestive and Kidney Diseases

      (http://digestive.niddk.nih.gov/ddiseases/pubs/indigestion/index.htm)

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