Stomach hurts: causes, symptoms and treatment

Pain and burning in the stomach, a feeling of fullness after eating and early satiety: these symptoms are familiar to many. These signs resemble gastritis.

But no changes in the mucous membrane are found. This condition is called functional dyspepsia.

The listed symptoms should bother the patient for at least the last three months, and their total duration should be at least six months.

At this time, functional dyspepsia is a rare diagnosis. Doctors still prefer to diagnose chronic gastritis.

Stomach overflow, pain and burning sensation, early satiety are the most common complaints in gastroenterological practice.

Functional dyspepsia with these symptoms is detected in 7-41% of the population. A quarter of them see a doctor at least 4 times a year. The disease is equally common in men and women.

Types of functional dyspepsia

Functional dyspepsia is divided into 2 forms:

• epigastric pain syndrome - the patient complains of pain in the navel or 2-3 cm above it. Moreover, this symptomatology occurs at least 1 time per week. Soreness is inconsistent, may appear after eating or on an empty stomach. Pain syndrome is always localized only in the epigastrium, does not decrease after bowel movement. Instead of pain, the patient may complain of a burning sensation in the epigastrium. Perhaps a combination with a feeling of fullness or early satiety;
• postprandial distress syndrome - the patient at least 3 times a week complains of a feeling of fullness in the stomach after taking the usual amounts of food. The patient may describe this sensation as early satiety. It is also possible the occurrence of nausea, pain in the epigastric region.

There are 3 types of functional dyspepsia:

• ulcerative - characterized by acute pain in the epigastrium. Soreness appears on an empty stomach or at night and is relieved by eating either proton pump inhibitors or antacids. Pain syndrome is more often provoked by stress;
• dyskinetic - accompanied by flatulence, rapid satiety, a feeling of fullness in the stomach, sometimes nausea;
• nonspecific - characterized by symptoms found in ulcerative and dyskinetic variants.

Causes

Why are there signs of functional dyspepsia? Unfortunately, the answer to this question cannot yet be given, since the causes of the disease have not been sufficiently studied.

Possible causes of functional dyspepsia include:

• heredity. It has been shown that children whose parents had symptoms of dyspepsia made the same complaint;
• improper nutrition. Patients with dyspepsia notice a worsening of their condition after eating red pepper, nuts, citrus fruits, mayonnaise, chocolate, coffee, carbonated drinks;
• smoking - leads to disruption of the motor activity of the stomach and increases the risk of developing dyspepsia by 2 times;
• previous infection of the gastrointestinal tract. As a result of studies, it became known that in 20% of patients who have had an infection, signs of functional dyspepsia appear. As a rule, such patients heal quickly;
• stress - it has been established that the disease occurs or worsens against the background of family, housing, financial or work problems. It is also known that people with functional dyspepsia have high levels of anxiety and depression.

All of these factors lead to an increase in the release of hydrochloric acid, impaired motor function and innervation of the stomach.

In patients with an ulcer-like variant of the course of the disease, an increase in the acidity of gastric juice is observed.

Also, in such patients, the secretion of alkalis in the antrum of the stomach is impaired. This leads to the appearance of pain in the epigastrium (in the navel and 2-3 cm above it).

In patients with dyskinetic variant of dyspepsia, there is a decrease in gastric acidity. Also, these patients are characterized by the throwing of intestinal contents into the stomach.

With functional dyspepsia, the motor activity of the stomach and duodenum is disturbed.

In most cases, after a meal, the fundus of the stomach does not relax properly, which leads to the rapid movement of food into the final compartment.

In this case, the stomach stretches, and the patient complains of a feeling of rapid satiety.

Also, patients may experience a decrease in the motor activity of the antrum and impaired coordination between the stomach and the duodenum.

As a result, the stomach empties slowly and feels full.

Patients with functional dyspepsia are hypersensitive to increased pressure within the stomach. The result of this hypersensitivity is epigastric pain.

Symptoms

Patients with functional dyspepsia complain of:

• epigastric pain (or discomfort);
• a feeling of fullness in the epigastric region after eating - a feeling of prolonged delay in food in the stomach;
• burning sensation in the epigastrium - burning sensations in the navel;
• early satiety - no matter how much the patient ate, he gets the feeling that the stomach is already full. As a result, the patient does not eat enough, which leads to a gradual weight loss and deterioration in well-being.

There are "symptoms of anxiety", the presence of which allows you to exclude functional dyspepsia:

• increased body temperature;
• admixture of blood in the feces;
• an increase in the number of leukocytes;
• a sharp decrease in weight by 10 kg or more;
• anemia (decrease in the number of red blood cells and hemoglobin levels);
• increased ESR.

Survey

Laboratory and instrumental research methods help to diagnose "Functional dyspepsia".

Laboratory research methods:

• general blood analysis;
• blood chemistry;
• analysis of feces for occult blood;
• tests for infection with Helicobacter pylori (urease, respiratory);
• serological methods of H. pylori diagnostics - search for antibodies to bacteria in the patient's blood;
• detection of Helicobacter pylori antigen in the patient's feces;
• detection of H. pylori DNA in feces and gastric mucosa.

Laboratory methods help differentiate functional dyspepsia from other gastrointestinal disorders.

Instrumental research methods:

• fibrogastroduodenoscopy (FGDS) - allows you to examine the tissues of the esophagus, stomach and duodenum. The diagnosis of functional dyspepsia is made only if the patient has no defects in the tissues of the stomach and intestines. If erosions or ulcers are detected, or there are cicatricial and ulcerative changes, then they speak of concomitant chronic gastritis or gastric ulcer. EGDS also allows you to establish the presence of a throw of intestinal contents into the stomach and gastric contents into the esophagus. In addition, during gastroscopy, the doctor takes a biopsy from a suspicious area for further examination of the material under a microscope;
• ultrasound examination of the abdominal organs - is carried out to assess the state of the gallbladder, pancreas, liver. Also, ultrasound examines the tone of the stomach and its peristaltic movements (contractions). Before this study, the patient drinks 300 ml of liquid. By the rhythmic contraction of the end part of the stomach and a decrease in its volume, it is judged how correctly and quickly the food passes into the lower parts of the gastrointestinal tract;
• X-ray examination of the stomach and duodenum with contrast - carried out for the differential diagnosis of peptic ulcer and dyspepsia. The study consists in the fact that the patient is given a contrast agent to drink before taking an X-ray. In the picture, the ulcer looks like a "niche". A spasm of muscle fibers on the side opposite to the ulcer is also determined. Various deformations can occur. Currently, this method is used less frequently than FGDS.
• Daily monitoring of acidity in the esophagus. This study is carried out within a day, and in some cases - within 48-72 hours. The level of acidity is measured if during EGDS no changes were found in the esophageal mucosa, but there are indications of reflux of gastric contents into the esophagus. The study helps to distinguish functional dyspepsia from GERD;
• Intragastric pH-metry;
• Gastric manometry - allows you to examine the pressure in the antrum of the stomach and in the duodenum and the contraction of these organs. The study is carried out on an empty stomach. The patient should not eat for 3 hours before the manometry.
• Electrogastrography - This test can also assess the motor function of the stomach.
• Computed tomography of the abdominal organs.

Which doctor to contact

If any symptoms appear, you should consult a therapist. He will prescribe the necessary examinations, draw up a treatment plan. Additionally, you may need to consult a gastroenterologist and a psychiatrist or psychotherapist.

Treatment

Treatment for functional dyspepsia includes diet and medication.

Diet

You need to eat at least 5 times a day, in small portions. From the diet, you need to exclude foods, the use of which causes the onset of symptoms. Most often, these products include:

• salty food;
• spicy;
• seasonings;
• coffee;
• alcoholic drinks;
• marinades;
• smoked meats;
• roast;
• sour (grape, citrus juices);
• strong tea.

It is important to quit smoking and long-term use of non-steroidal anti-inflammatory drugs.

It is useful to keep a “food diary” in which you need to write down all the foods you eat and record the onset of symptoms.

Drug treatment

According to the results of the survey, most patients try to stop the symptoms by taking Antacids. However, studies have shown that antacids are ineffective for functional dyspepsia.

Antisecretory drugs have a pronounced effect on the signs of functional dyspepsia (see Proton pump inhibitors and H₂-blockers).

Currently, the issue of eradication therapy for the bacteria Helicobacter pylori is controversial. On the one hand, with functional dyspepsia, H. pylori may not be present in the body.

But on the other hand, functional dyspepsia can be combined with chronic gastritis, one of the main causes of which is the bacterium Helicobacter pylori.

In addition, eradication therapy reduces the likelihood of developing gastric ulcers and cancer in patients with functional dyspepsia and gastritis.

IPP

This group includes Pantoprazole, Lansoprazole, Omeprazole, Esomeprazole, Rabeprazole.

At the moment, PPIs are most effective in maintaining the required level of acidity in the stomach, eliminating the symptoms of functional dyspepsia.

Studies have shown that proton pump inhibitors are more effective for dyspeptic symptoms than H₂-blockers.

However, this group of drugs only helps with ulcerative dyspepsia. The effect of taking PPIs with dyskinetic variant is not observed.

H₂-blockers

This group includes drugs such as Ranitidine, Famotide, Cimetidine, Roxatidine. They maintain optimal acidity of gastric juice by inhibiting the secretion of hydrochloric acid.

They are less effective than proton pump inhibitors. H₂-blockers - drugs of choice in the treatment of dyspepsia in children.

Prokinetics

These are drugs that normalize the contractile activity of the organs of the gastrointestinal tract. This group includes Domperidone, Metoclopramide, Itoprid hydrochloride.

Currently, metoclopramide is rarely used due to many side reactions.

Domperidone can be used to relieve nausea and vomiting, but not more than 7 days. The drug is contraindicated in pregnant women, children under 12 years of age, patients with hepatic insufficiency and people with low (less than 35 kg) body weight.

Itoprida hydrochloride is the drug of choice for functional dyspepsia.

The medicine eliminates the heaviness in the epigastric region after eating, the feeling of early satiety and improves the general condition. It is necessary to take Itoprid hydrochloride for at least 8 weeks.

Iberogast

Iberogast is a herbal preparation that is used, among other things, in the treatment of functional dyspepsia.

This remedy normalizes the process of moving food from the stomach into the duodenum, eliminates pain in the epigastrium, reduces the acidity of gastric juice, improves the formation of protective mucus in stomach. Iberogast is well tolerated by patients.

H. pylori eradication

To eliminate the bacteria Helicobacter pylori, antibacterial drugs are used. Special schemes of eradication therapy have been developed.

Triple scheme:

• PPI (in a standard dose twice a day);
• Clarithromycin 500 mg 2 times a day;
• Amoxicillin 1000 mg 2 times a day.

The duration of therapy is at least 7 days.

If this regimen is ineffective or there is an allergy to penicillins, then quadrotherapy may be prescribed.

• PPI (in a standard dose twice a day);
• De-Nol (120 mg 4 times a day);
• Tetracycline 500 mg 4 times a day;
• Metronidazole 500 mg 3 times a day.

The duration of treatment is at least 10 days.

If there is no effect, they switch to the next scheme, which is prescribed only by a gastroenterologist.

How to find the right treatment?

You don't need to take all of these drugs. Which medication to choose depends on what form of the disease you have.

So, with an ulcer-like variant, it is necessary to take proton pump inhibitors or H₂-blockers.

Patients with dyskinetic variant of functional dyspepsia are shown Itoprid hydrochloride or Iberogast. Some authors recommend the use of Iberoast for all forms of functional dyspepsia.

Eradication therapy Helicobacter pylori is prescribed to all patients.

Treatment in all cases should last at least 4 weeks. Further therapy is selected individually, depending on the effectiveness of the treatment.

If the symptoms of the disease persist, then a deeper examination of the patient should be carried out.

Folk remedies

Folk remedies can only complement drug treatment. Before taking infusions and decoctions, you need to consult your doctor.

Traditional medicine recipes:

• Pour 10 g of dill seeds with a glass of boiling water and leave for 20 minutes. Take 2 tbsp. l. after meal;
• mix chamomile, sage, mint, yarrow. Pour 5 g of the mixture with a glass of boiling water. Insist for 15 minutes. Drink 100 ml three times a day before meals. This recipe will help relieve pain quickly;
• pour a teaspoon of fennel fruits with a glass of boiling water and put on fire. Simmer for 15 minutes. Cool and drain. Add boiling water to the resulting broth to make 200 ml. Drink during the day in small portions;
• 15 g of elecampane root pour 200 ml of boiling water. Insist for 8 hours, drain. Take a third of a glass three times a day before meals. Course - 2 weeks;
• yarrow herb, buckthorn bark, yarrow herb, anise pods, mustard seeds, licorice root mix. Pour 15 g of the mixture with 1.5 cups of boiling water, insist for half an hour. Take 150 ml in the morning and evening.

Prophylaxis

How to avoid the occurrence of functional dyspepsia? There are a few rules to follow:

• stop drinking alcohol and smoking;
• avoid eating those foods that lead to symptoms of dyspepsia;
• eat at least 5-6 times a day, in small portions;
• avoid stress.

Conclusion

Functional dyspepsia is a complex of symptoms that include soreness and burning in the epigastric region, a feeling of fullness after eating, and early satiety.

Such symptoms should be present in the patient for at least 3 recent months. At the same time, damage to the mucous membrane and ulcers in the organs of the gastrointestinal tract is not observed.

The disease, in some cases, is combined with gastritis or peptic ulcer disease. The reasons can be hereditary predisposition, stress, unhealthy diet, alcohol intake and smoking.

The disease may resemble a peptic ulcer (ulcer-like varinat) or be accompanied by flatulence, nausea, vomiting, a feeling of fullness in the epigastrium (dyskinetic variant).

Diagnosis of the disease is based on laboratory and instrumental research methods. The diagnosis is made by gastroscopy, based on the absence of changes in the organs of the gastrointestinal tract.

Also used x-ray with barium, ultrasound of the abdominal organs, daily monitoring of acidity in the esophagus, computed tomography.

Less commonly used intragastric pH-metry, gastric manometry, electrogastrography. Treatment of the disease depends on its form.

With an ulcer-like variant, an PPI or N is prescribed₂blockers. With the dyskinetic variant, prokinetics are used. H. pylori eradication therapy is indicated for all patients.

Together with drug treatment, a diet is prescribed. To avoid the appearance of functional dyspepsia, you need to eat right, eat at least 5 times a day.

It is necessary to give up alcohol and smoking. It's important to avoid stress. If you experience any symptoms of dyspepsia, you should immediately consult a specialist.