Is My Upper Abdominal Pain Dyspepsia?

What is Dyspepsia?

Dyspepsia is a medical term for the symptoms of chronic or recurrent upper abdominal pain or discomfort. In some patients, the discomfort might be more specifically described as:

• Feeling full quickly when eating
• Bloating
• Feeling full all the time
• Nausea

In contrast, if the symptoms of heartburn or acid regurgitation predominate, this is considered to be gastroesophageal reflux disease (GERD). 

What is the Initial Workup and Treatment of Dyspepsia?

An upper endoscopy is indicated if dyspepsia occurs in patients older than 55 years of age or if any of the following “alarm features” are present: 

• Evidence of bleeding from the GI tract
• Anemia (low blood counts)
• Unintended weight loss (more than 10%)
• Trouble or pain with swallowing
• Persistent vomiting
• Having a relative with stomach cancer
• Previous personal history of esophageal or stomach cancer
• Previous personal history of stomach ulcer
• Swollen lymph nodes
• Unusual mass in the stomach

"If the patient is 55 years or younger, and no alarm features are present, a doctor may consider either testing and treating for a stomach bacteria, called H. pylori, or consider one to two months of treatment with an acid-blocking medication," explains Dr. Dryer.  "If neither of these treatments help, an upper endoscopy might be a reasonable next step."

What Might be Found on Upper Endoscopy?

The majority of the time, there is no significant irritation found in the stomach. Though the stomach pain is real, the exact cause cannot always be found. Research suggests that one of several problems may be occurring: 

• Motor or nerve problems leading to slow stomach emptying
• Increased sensitivity in the stomach to food and the normal stretching to hold the food
• Infection with H. pylori
• Psychological and social stressors

Some of the time, there is mild irritation, called “gastritis”, but not ulceration. Many things can cause this including: 

• Medications (such as ibuprofen and aspirin products)
• Alcohol
• H. pylori
• Caffeinated beverages
• Bile from the intestines
• Stress

About five to ten percent of the time, an ulcer may be found.  "The most common causes of this are, again, H. pylori and medications like ibuprofen and aspirin," Dr. Dryer Says. "Very rarely, a stomach ulcer is related to cancer or chemotherapy related medicines." 

If No Irritation is Found, How is Dyspepsia Treated?

A patient’s treatment will depend on symptoms. Findings during the workup and tailored to the specific situation, which may include:

• Dietary changes: Avoiding large, fatty meals and any foods that make symptoms worse
• Acid-blocking medicines: Proton pump inhibitors (PPIs) such as omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), dexlansoprazole (Dexilant), pantoprazole (Protonix), etc...
• Histamine blockers: Ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet), etc...
• H. pylori treatment: Combination of specific antibiotics and acid-blocking medicines
• Pain medicines: Low doses of certain antidepressant medications (even if the patient isn’t depressed) such as amitriptyline or nortriptyline.

Other times a nerve pain medicine, called gabapentin, or medicines that speed up gastric emptying may be used. Complementary medicines, such as peppermint or caraway, might also be tried, though they have much less research behind them. Very rarely, narcotics are used because of concerns about the side effects including addiction and constipation.

Sometimes, depending on the case, additional workup is reasonable if the patient has no response to treatments.