Pain in the upper abdomen can be caused by dyspepsia. Dyspepsia refers to a disturbance in the upper part of the digestive tract (esophagus, stomach and/or small intestine), mainly causing stomach complaints – such as pain in the upper abdomen, regurgitation and belching, nausea and sometimes even vomiting. In approximately 50 percent of people with dyspepsia, no organic cause can be found and this is referred to as ‘functional dyspepsia’, also called ‘non-specific stomach complaints’ or ‘hypersensitive stomach’. Functional dyspepsia refers to chronic or recurrent upper abdominal complaints lasting at least 4 weeks, not related to exercise, without an identifiable cause. The complaints probably arise from a hypersensitive stomach and/or disturbed movements of the stomach.
Pain in the upper abdomen
- Upper abdominal pain: two forms of dyspepsia
- Possible causes of functional dyspepsia
- Hypersensitive stomach
- Lazy stomach
- Symptoms of functional dyspepsia
- Diagnosis and research
- Treatment of upper abdominal pain due to dyspepsia
- Dietary advice and lifestyle habits change
Upper abdominal pain: two forms of dyspepsia
dyspepsia are distinguished:
- organic dyspepsia, where the cause is known; and
- functional dyspepsia, in which no organic abnormality or clear cause is found.
The possible causes of organic dyspepsia include:
- excessive stomach acid production;
- reflux of stomach acid;
- excessive eating and drinking (i.e. too much and too often);
- gastric mucosal inflammation;
- stomach ulcer.
In the present article we limit ourselves to functional dyspepsia.
Possible causes of functional dyspepsia
The two most common causes of functional stomach complaints are:
- a hypersensitive stomach; and
- delayed gastric emptying, also called ‘lazy stomach’.
Someone with a hypersensitive stomach is hypersensitive to stimuli from the gastrointestinal tract. It is not clear why this is the case. A combination of several factors probably plays a role, including:
- a previous infection;
- a disturbed stomach movement;
- the diet; and
- psychological factors such as persistent stress.
A lazy stomach indicates delayed gastric emptying, where the stomach muscle contracts too little or too irregularly. The result is that the food is not sufficiently ground and remains in the stomach longer than normal. Often the cause of a lazy stomach is not known. Stress and tension may play a role.
Symptoms of functional dyspepsia
Complaints that may occur with functional dyspepsia are:
- pain in the upper abdomen;
Nausea / Source: Istock.com/CentralITAlliance
- stomach ache;
- distension or bloating of the stomach after meals;
- bad or unpleasant taste in the mouth and/or bad breath;
- burping and regurgitation;
- being able to eat little, feeling full quickly;
The complaints can be very annoying and interfere with your daily activities.
Diagnosis and research
The diagnosis of functional dyspepsia can be made when no abnormalities are found on examination and there are persistent stomach complaints. The upper abdominal complaints are probably caused by a hypersensitive stomach and/or disturbed movements of the stomach. Examination may consist of gastroscopy (a visual examination of the stomach) and a gastric emptying examination . The latter is done by means of a standardized test breakfast including radioactive jam, after which images are taken of the stomach at a number of times. These images allow the speed at which the meal disappears from your stomach to be calculated.
Coffee can worsen the complaints / Source: Istock.com/PuwanaiSomwan
Treatment of upper abdominal pain due to dyspepsia
Since the cause of the complaints is not known, it is difficult to treat functional dyspepsia in a targeted and adequate manner. Nutritional advice and changing certain lifestyle habits can help reduce symptoms in some cases. The doctor can also prescribe a medication for the pain. In the case of a hypersensitive stomach, low doses of certain antidepressants can somewhat reduce the stimuli from the gastrointestinal tract. In case of delayed gastric emptying, prokinetics can be prescribed, such as Domperidone and Metoclopramide. These are medications that stimulate the muscles in the stomach.
Dietary advice and lifestyle habits change
The following advice regarding lifestyle and eating patterns can help reduce the complaints:
- Avoid bending and lifting, especially after eating (when you have a full stomach). When you bend over, the stomach acid flows a little way towards the esophagus and when you bend or lift you push the contents of your stomach up.
- Do not lie down after meals, as this will make it easier for the acidic contents of the stomach to flow back into the esophagus.
- Certain foods can worsen symptoms in some people. Well-known examples are coffee, peppermint, chocolate, carbonated drinks, alcohol, orange juice, (strongly) spicy food and fatty food. Avoid these foods if they bother you.
Eat small portions throughout the day / Source: Losangela/Shutterstock.com
- Don’t eat too much fat and don’t eat too much. Eat smaller portions throughout the day: six small meals a day are preferable to three large ones.
- Don’t eat in a hurry, but take your time and chew well.
- Avoid tight clothing, because tight clothing presses on the stomach and can push stomach acid into the esophagus.
- Aim for a good weight. A fat belly constantly pushes on the stomach.
- Stop smoking. Smoking can worsen the symptoms in some people.
- Avoid stress and ensure sufficient relaxation. With persistent tension and stress, your body produces more stomach acid and the squeezing movement of the stomach can become more irregular or delayed.
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