Patient education: Upset stomach (functional dyspepsia) in adults (Beyond the Basics)

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. 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 education: Chronic abdominal pain in children and adolescents (Beyond the Basics)".)

More detailed information about dyspepsia is available by subscription. (See "Functional dyspepsia in adults" and "Approach to the adult 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 education: Helicobacter pylori infection and treatment (Beyond the Basics)".)

Functional dyspepsia occasionally begins with acute gastroenteritis, usually due to a bacterial or viral infection. Dyspepsia can persist long after the infection subsides, perhaps caused by a change in the bacteria that normally live in the gastrointestinal tract.

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 determine if you might have a cause of symptoms different from functional dyspepsia, 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 (ascending burning sensation beneath the sternum ("breastbone")?

●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?

●Do you have a family history of stomach cancer?

Testing recommendations — The best way to diagnose functional dyspepsia is not clear. Some experts recommend the following:

●If you are 60 or older 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 education: Upper endoscopy (Beyond the Basics)".)

●If you are younger than 60 or you do not have serious symptoms or family history of stomach cancer, you might be offered other types of testing. This might include a breath, blood, or stool test for H. pylori. (See "Patient education: Helicobacter pylori infection and treatment (Beyond the Basics)".)

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.

●Avoiding too much alcohol.

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 (Dexilant), pantoprazole (Protonix), and rabeprazole (AcipHex).

●Histamine blockers might help some people. Examples include famotidine (Pepcid), cimetidine (Tagamet), and nizatidine (Axid).

In 2020, the US Food and Drug Administration (FDA) removed another histamine blocker, ranitidine (brand name: Zantac), from the market. This happened after testing showed that some products were found to be contaminated with a substance that can increase a person's risk of cancer if consumed at high enough levels over time. This medication will no longer be available in stores or pharmacies. If you have this medication in your home, you should stop taking it and throw away any that is left over. Your health care provider can suggest another medication to help with your symptoms.

●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 dyspepsia. (See "Patient education: Helicobacter pylori infection and treatment (Beyond the Basics)".)

If you test positive for H. pylori, talk to your doctor or nurse to see if you should be treated. In functional dyspepsia, treating H. pylori sometimes helps to reduce symptoms.

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 (Advil, Motrin), and naproxen (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 no well performed medical 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 Center for Complementary and Integrative Health website.

WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Stomach ache and stomach upset (The Basics)
Patient education: Peptic ulcers (The Basics)
Patient education: Lactose intolerance (The Basics)
Patient education: Abdominal pain (The Basics)
Patient education: Gastritis (The Basics)
Patient education: Ischemic bowel disease (The Basics)
Patient education: Stomach cancer (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Chronic abdominal pain in children and adolescents (Beyond the Basics)
Patient education: Helicobacter pylori infection and treatment (Beyond the Basics)
Patient education: Upper endoscopy (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Approach to the adult with dyspepsia
Anterior cutaneous nerve entrapment syndrome
Evaluation of the adult with abdominal pain
Causes of abdominal pain in adults
Functional dyspepsia in adults

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

     (https://www.niddk.nih.gov/health-information/digestive-diseases/indigestion-dyspepsia)

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