Non ulcer dyspepsia is a chronic disorder of sensation and movement in the upper digestive tract. Non-ulcer dyspepsia is also called non ulcer stomach pain or functional dyspepsia.
People with non ulcer dyspepsia may experience heartburn, fullness after a meal or before finishing a meal, nausea after meals, excessive belching, and pain, burning, or swelling in the upper abdomen.
What is non ulcer dyspepsia?
Non ulcer dyspepsia (functional dyspepsia) is a functional disease of the upper digestive system, in which there is no inflammation and the symptoms are similar to those of inflammatory gastritis. It is a common diagnosis, even more frequent than gastritis or peptic ulcer.
This diagnosis is made when different symptoms such as pain in the pit of the stomach (epigastric), abdominal distension (sensation of inflammation), or nausea are present independently or in combination.
These symptoms are similar to ulcer disease, when the patient is studied with procedures that allow visualization of the upper digestive tract (endoscopy) it is confirmed that there is no anatomical lesion. In other words, the patient presents symptoms of ulcer (dyspepsia) but there is no ulcer or gastritis and clinical criteria known as the Rome criteria are met to establish the diagnosis.
Non ulcer dyspepsia is probably more common than ulcer disease and is frequently associated with irritable bowel.
This type of dyspepsia is the most frequent and represents 65% of consultations for these symptoms. Your family doctor will rule out the presence of any pathology that explains the symptom, such as gastroduodenal ulcer, or cancer, among others, and in addition to other associated pathologies such as irritable bowel syndrome and gallstones.
What is dyspepsia?
If all patients with dyspepsia were studied, a large part would not find any demonstrable abnormality. Your GP will be able to help you live with and tolerate some diagnostic uncertainty.
It Is important that at the time of consultation you know how to identify the different symptoms that you present, since the description will make it possible for your doctor to choose a treatment that best suits the symptoms that you present.
- Reflux-type dyspepsia: heartburn and regurgitation predominate. The burning sensation can radiate towards the neck and can worsen with copious intakes and when lying down or bending over and is usually relieved with antacids.
- Ulcer-type dyspepsia: epigastric pain predominates with exacerbations and remissions, calm with food or antacids.
- Dysmotility-type dyspepsia: bloating, bloating, early satiety, nausea, and digestive discomfort predominate.
Non ulcer dyspepsia causes
The causes of non ulcer dyspepsia (functional dyspepsia) are unknown and probably multiple. There is some evidence that implies a certain genetic predisposition. Although Helicobacter pylori infection can produce symptoms of dyspepsia in a small group of patients, there is little information to support the role of this bacterium in causing symptoms in the majority of patients. Psychological factors may influence the symptom experience in some patients with non ulcer dyspepsia.
Changes in gastric function have been identified in many patients with non ulcer dyspepsia. In approximately 40% of patients with dyspepsia, the stomach does not relax normally in response to a meal. This is known as “impaired gastric accommodation” and may be associated with symptoms of fullness and pressure in some patients.
Abnormalities in gastric contractions and emptying are also observed in a similar percentage of patients. Impaired gastric emptying has been associated with symptoms of bloating and early fullness. At least two thirds of patients with me non-ulcer dyspepsia have increased perception of gastric activity, which is called visceral hypersensitivity.
Often seen in non ulcer dyspepsia, visceral hypersensitivity is not particularly associated with any specific symptom.
Non ulcer dyspepsia symptoms
- Burning in the pit of the stomach
Non ulcer dyspepsia diagnosis
Your doctor will likely review your signs and symptoms and do a physical exam. Various diagnostic tests can help your doctor determine the cause of your discomfort and rule out other disorders that cause similar symptoms. Among the options are the following:
- Blood test. Blood tests can help rule out other conditions that can cause signs and symptoms similar to those of non ulcer dyspepsia.
- Tests to detect a bacterium. Your doctor may recommend a test to check for a bacterium called helicobacter pylori (H. pylori) that can cause stomach problems. The helicobacter pylori test can use your blood, your stool, or your breath.
- Endoscopy. A thin, flexible, lighted instrument (endoscope) is passed down your throat so your doctor can see your esophagus, stomach, and the first part of your small intestine (duodenum). This will also allow your doctor to collect small tissue samples from the duodenum to look for inflammation.
In some cases, additional tests may be considered to assess the emptying and relaxation (accommodation) of the stomach.
When to see the doctor
Make an appointment with your doctor if you experience persistent signs and symptoms that worry you.
- Vomiting blood
- Dark-colored or tar-like stools
- Shortness of breath
- Pain that spreads to the jaw, neck, or arm
- Weight loss without apparent cause
Risk factor’s of functional dyspepsia
Factors that may increase the risk of functional dyspepsia include:
- Female gender
- Use of certain over-the-counter pain relievers, such as aspirin and ibuprofen (Advil, Motrin IB, others), which can cause stomach problems
- Anxiety or depression
- History of physical or sexual abuse in childhood
- Helicobacter pylori infection
Treatment of non-ulcer dyspepsia
Functional dyspepsia that is longstanding and cannot be controlled with lifestyle changes may require treatment. The treatment you receive will depend on your signs and symptoms. Treatment may combine medication with behavioral therapy.
- Over-the-counter remedies for gas. Medications that contain the ingredient simethicone may provide some relief by reducing intestinal gas. Some examples of gas relief remedies are 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), and nizatidine (Axid AR). Stronger versions of these drugs are sold by prescription.
- Drugs that block acid \”pumps\” Proton pump inhibitors turn off acid \”pumps\” inside stomach cells that secrete acid.
Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24HR), omeprazole (OTC Prilosec), and esopremazole (Nexium 24HR). Proton pump inhibitors are also available by prescription.
- Antibiotics If tests indicate that you have a common bacterium that causes stomach ulcers, called helicobacter pylori, your doctor may recommend antibiotics combined with acid-suppressing medications.
- Low-dose antidepressants. Tricyclic antidepressants and drugs known as selective serotonin reuptake inhibitors, taken in low doses, can help inhibit the activity of neurons that control intestinal pain.
- Prokinetics. Prokinetic agents help the stomach empty more quickly and may help to contract the valve between the stomach and the esophagus, reducing the likelihood of upper abdominal discomfort.
- Medications to relieve nausea (antiemetics). If you feel nauseated after eating, your doctor may recommend an antiemetic, such as promethazine, prochlorperazine, or meclizine.
Working with a counselor or therapist can help relieve signs and symptoms that don’t improve with medication. A counselor or therapist can teach you relaxation techniques that can help you cope with your signs and symptoms.
Lifestyle and home remedies
Your doctor may recommend lifestyle changes to help you manage non ulcer dyspepsia.
Make changes to your diet
Changes to your diet and the way you eat can help control your signs and symptoms. Consider trying the following:
- Eat smaller portions more often. Having an empty stomach can sometimes lead to functional dyspepsia. Having nothing but acid in your stomach can make you feel sick. Try to eat a small snack, like a cracker or a piece of fruit.
- Avoid skipping meals. Avoid large meals and overeating. Eat smaller portions more often.
- Avoid trigger foods. Some foods can trigger non ulcer dyspepsia, such as fatty and spicy foods, carbonated drinks, caffeine, and alcohol.
- Chew your food slowly and completely. Give yourself time to eat slowly.
Reduce stress in your daily life
Stress reduction techniques or relaxation therapy can help you manage your signs and symptoms. To reduce stress, spend time doing things you enjoy, like hobbies or sports.
People with functional dyspepsia often turn to complementary and alternative medicine to help them cope. Additional studies are needed before alternative and complementary treatments are recommended, but when used in conjunction with physician care, they may provide relief from signs and symptoms.
If you are interested in complementary and alternative treatments, talk to your doctor about:
- Herbal supplements. Herbal remedies that may have some benefit for functional dyspepsia are a combination of peppermint and caraway oil, which alleviated pain symptoms in a 4-week trial. Iberogast (STW5), a therapy containing extracts from nine medicinal plants, can improve intestinal motility and relieve gastrointestinal spasms.
- Rikkunshito, a Japanese herbal remedy, also appears to be beneficial, showing significant improvements in abdominal pain, heartburn, and bloating, more than those reported with placebos. Artichoke leaf extract may reduce other symptoms of non ulcer dyspepsia, including vomiting, nausea, and abdominal pain.
- Relaxation techniques. Activities that help you relax can also help manage and deal with signs and symptoms. Consider trying meditation, exercise, or other activities that can help reduce your stress levels.
There are no serious complications since the disease is benign although difficult to control, so vigilance is required to control symptoms.
Which patients are considered to be at higher risk for gastroduodenal ulcer or cancer?
- Use of non-steroidal anti-inflammatory drugs
- History of gastroduodenal ulcer in first degree relatives (parents, siblings and/or children)
- History of previous gastroduodenal ulcer
- Longstanding symptoms
- Other chronic diseases: COPD, cirrhosis, urethritis, hyperparathyroidism
- Onset of symptoms in people over 50 years of age.
Most low-risk patients will receive empirical treatment, and if the treatment fails, your doctor may consider requesting additional studies.
The food plan In the first instance will consist of identifying which are the foods that precipitate the symptoms that it presents in order to exclude them. Among the foods that produce the greatest exacerbation of dyspepsia are: analgesics, coffee, tobacco and alcohol.
The type of dyspepsia will guide your doctor in the choice of drugs to relieve symptoms. The duration of treatment will be at least 4 to 8 weeks.
Remember that it is very important to see your GP if you have dyspepsia for a full evaluation, individualized treatment and proper follow-up.
Non ulcer dyspepsia is a common digestive disorder that remains poorly understood. Ongoing research seeks to define the causes and effective treatment.