Food passes down the oesophagus (gullet) into the stomach. The stomach
makes acid which is not essential, but helps to digest food. Food then
passes gradually into the duodenum (the first part of the small
intestine).
In
the duodenum and the rest of the small intestine, food mixes with
enzymes (chemicals). The enzymes come from the pancreas and from cells
lining the intestine. The enzymes break down (digest) the food.
Digested food is then absorbed into the body from the small intestine.
What is dyspepsia?
Dyspepsia is a term which
includes a group of symptoms that come from a problem in your upper
gut. The gut or 'gastrointestinal tract' is the tube that starts at the
mouth, and ends at the anus. The upper gut includes the oesophagus,
stomach, and duodenum.
The main symptom of dyspepsia is
usually pain or discomfort in the upper abdomen. In addition, other
symptoms that may also develop include: heartburn (a burning sensation
felt in the lower chest area), bloating, belching, quickly feeling
'full' after eating, feeling sick (nausea) or vomiting. Symptoms are
often related to eating. Symptoms tend to occur in 'bouts' which come
and go, rather than being present all the time. However, some people
have frequent bouts of dyspepsia which affects quality of life.
What is non-ulcer dyspepsia?
Non-ulcer
dyspepsia is sometimes called functional dyspepsia. It means that no
known cause can be found for the symptoms. That is, other causes for
dyspepsia such as duodenal ulcer, stomach ulcer, oesophagitis (inflamed
oesophagus), gastritis (inflammed stomach), etc, are not the cause. The
inside of your gut looks normal (if you have an endoscopy - see below).
It is the most common cause of dyspepsia. About 6 in 10 people who have
recurring bouts of dyspepsia have non-ulcer dyspepsia.
What causes non-ulcer dyspepsia?
The
symptoms seem to come from the upper gut, but the cause is not known.
If you have tests, nothing abnormal is found inside your gut. The
lining inside your gut looks normal and is not inflamed. The amount of
acid in the stomach is normal.
The following are some theories as to possible causes:
- Sensation
in the stomach or duodenum may be altered in some way - an 'irritable
stomach'. About 1 in 3 people with non-ulcer dyspepsia also have
'irritable bowel syndrome' and have additional symptoms of lower
abdominal pains, erratic bowel movements, etc. The cause of irritable
bowel syndrome is not known.
- A delay in emptying the stomach contents into the duodenum may be a
factor in some cases. The muscles in the stomach wall may not work as
well as they should.
- Infection with a bacterium (germ) called H. pylori may cause
some cases. This bacterium is found in the stomach in some people with
non-ulcer dyspepsia. However, many people are 'carriers' of this
bacterium, and it causes no symptoms in most people. The role of H. pylori
is controversial in non-ulcer dyspepsia (although it is the main cause
of duodenal and stomach ulcers). However, getting rid of H. pylori infection helps in some cases.
- Some people feel that certain foods and drinks may cause the
symptoms or make them worse. It is difficult to prove this. Foods and
drinks that have been suspected of causing symptoms or making symptoms
worse in some people include: peppermint, tomatoes, chocolate, spicy
foods, hot drinks, coffee, and alcoholic drinks. However, food is not
thought to be a major factor in most cases.
- Anxiety, depression, or stress are thought to make symptoms worse in some cases.
- A side-effect of some drugs can cause dyspepsia. The most common
culprits are anti-inflammatory drugs such as ibuprofen and aspirin.
Various other drugs which sometimes cause dyspepsia, or make dyspepsia
worse, include: antibiotics, steroids, iron, calcium antagonists,
nitrates, theophyllines, bisphosphonates. (Note: this is not an
exhaustive list. Check with the leaflet that comes with your medication
for a list of possible side-effects.) If you suspect a prescribed drug
is causing the symptoms, or making them worse, then see your doctor to
discuss possible alternatives.
What tests may be done?
Strictly speaking,
non-ulcer dyspepsia is a diagnosis that is made only when no other
cause can be found for the symptoms (such as an ulcer). Therefore,
prior to the diagnosis being made you may have had an endoscopy. In
this test a doctor looks inside your stomach and duodenum by passing a
thin, flexible telescope down your oesophagus. If you have non-ulcer
dyspepsia, the inside of your gut looks normal. However, most people
with dyspepsia do not have an endoscopy. See separate leaflet called 'Dyspepsia (Indigestion)' for an overview of dyspepsia, and when tests are advised.
A test to detect the H. pylori bacterium may be done. If H. pylori is found then it may be causing the symptoms. See separate leaflet called 'Helicobacter Pylori & Stomach Pain' for more details about H. pylori
and how it can be diagnosed. Briefly, it can be detected in a sample of
faeces, or in a 'breath test', or from a blood test, or from a biopsy
sample taken during an endoscopy.
What are the treatment options for non-ulcer dyspepsia?
Reassurance and explanation
This is often
helpful. Some people worry that they may have a serious disease such as
stomach cancer. Worry and anxiety can make symptoms worse. It may be
useful to know that you have non-ulcer dyspepsia, and not some other
disease. However, you will have to accept that pain, discomfort and
other 'dyspeptic' symptoms are likely to 'come and go'.
Clearing H. pylori infection
If you are infected with H. pylori, the first treatment usually tried is to clear the H. pylori infection. However, as mentioned, infection with H. pylori
is probably a coincidence rather than a cause in most cases of
non-ulcer dyspepsia. For example, one study found that only about 1 in
15 people with non-ulcer dyspepsia who were infected with H. pylori were cured by clearing H. pylori. Another leaflet deals with the treatment of H. pylori. Briefly, it involves a one week course of two antibiotics plus an acid suppressing drug.
Acid suppressing drugs
A one month trial of
medication that reduces stomach acid is often advised. This helps in
some cases, but not all. It may work because the lining of your stomach
may be extra sensitive to the acid. Or, it may work because you may
have very mild inflammation in your stomach that 'comes and goes', but
is never found if you have an endoscopy test to look into your stomach.
There are two groups of drugs that reduce stomach acid -
'proton pump inhibitors (PPIs)' and 'H2 blockers'. They work in
different ways but both reduce (suppress) the amount of acid that the
stomach makes. Proton pump inhibitors include: omeprazole,
lansoprazole, pantoprazole, rabeprazole, and esomeprazole. H2 blockers
include: cimetidine, famotidine, nizatidine, and ranitidine. There are
several brands in each group.
If medication helps, then further
courses may be advised if symptoms persist. Many people take acid
suppressing medication 'as required'. That is, waiting for symptoms to
develop before taking a short course of treatment. Some people take
acid suppressing medication regularly if symptoms occur each day.
Prokinetic medicines
These include drugs
called domperidone and metoclopramide. They help to speed up the
passage of food through the stomach and may help with symptoms of
bloating and feeling sick. There has been little research done to prove
how effective these drugs are for non-ulcer dyspepsia, but one may be
worth a try if other treatments do not help.
Lifestyle changes
There is no clear evidence
that lifestyle factors affect dyspepsia. However, some people find that
some things seem to make a difference. For example:
-
Some foods
may make symptoms worse in some people. It is difficult to be certain
how much foods contribute. Let common sense be your guide. If it seems
that a food is causing symptoms, then try avoiding it for a while to
see if symptoms improve. Foods that have been suspected of making
symptoms worse are listed earlier.
-
Smoking. Some smokers find that symptoms improve if they give up smoking.
-
Weight. If you are overweight then losing some weight may ease the symptoms.
What is the outlook (prognosis)?
Symptoms of
non-ulcer dyspepsia tend to come and go. You are likely to have times
when symptoms go completely, and times where they are troublesome.
Non-ulcer dyspepsia does not lead to cancer or other serious illnesses.
Disclaimer: This article is for information only and should not
be used for the diagnosis or treatment of medical conditions. EMIS and
PiP have used all reasonable care in compiling the information but make
no warranty as to its accuracy. Consult a doctor or other health care
professional for diagnosis and treatment of medical conditions.
© EMIS and PiP 2008 Reviewed: 23 Aug 2008
