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Nonulcer dyspepsia

By Amindra Arora, M.D.
Associate Medical Editor, Mayo Clinic Health Letter

Sometimes, people will see their doctors for what they think are the signs and symptoms of an ulcer. Although they may have gnawing upper abdominal pain, diagnostic tests don't reveal a digestive problem — all test results come back normal.

Many of these people have a condition known as nonulcer dyspepsia (dis-PEP-see-uh), or functional dyspepsia. It's a condition that brings the discomfort of an ulcer without an ulcer. (See the March 2011 cover article "Peptic ulcers: Stopping them for good.")

Nonulcer dyspepsia is common and can be long lasting. Unfortunately, it appears to occur for no apparent reason. Its most common symptom is pain, or an uncomfortable feeling, in your upper abdomen. Other signs and symptoms may include gas, bloating, nausea or feeling full after eating only a moderate amount of food.

As with ulcers, the pain is often, but not always, relieved with food or antacids. It's possible to control the condition with changes to your diet and lifestyle, but medications are sometimes helpful for managing the symptoms.

Although the cause (or causes) of nonulcer dyspepsia is largely unknown, it's possible that the pain stems from an irritation to your stomach lining. Researchers have considered other theories as well.

  • Presence of H. pylori bacteria — Your symptoms may represent an early case of H. pylori infection, despite the fact that no ulcer has developed.

  • Reaction to drugs and supplements — Pain relievers such as aspirin and other NSAIDs are known to cause ulcers and gastritis. It's possible these medications can irritate your digestive system without damaging your stomach or intestines. This may be true for other drugs and supplements, including antibiotics, steroids, minerals and herbs.

  • Overproduction of stomach acid — Acid-secreting cells in your stomach may produce higher than normal amounts of digestive acid. The oversupply may irritate digestive tissues.

  • Stomach disorder — For unknown reasons, your stomach may not be functioning or emptying normally. This sometimes happens after certain viral infections.

  • Acid sensitivity — Tissues lining the stomach and duodenum may be overly sensitive to normal acid levels and become easily irritated.

  • Food sensitivity — Your stomach or intestines may be overly sensitive to certain kinds of food or food ingredients. Often, but not always, these include certain spices, citrus fruits or vegetables that contain moderate to high levels of acid. Some people find that drinking coffee seems to make the symptoms worse.

  • Overreaction to normal stimuli — Nerve signals between your stomach and brain may be faulty, resulting in an exaggerated response to the normal changes taking place during digestion, such as how your stomach stretches and expands as it fills with food. This overreaction is known as visceral hypersensitivity.

  • Stress — Pain may be your body's way of responding to periods of stress.

  • Psychological disorder — Depression, anxiety or another factor affecting your emotional health may have a role in causing your symptoms, for example, increasing your awareness and sensitivity to pain and discomfort.

The symptoms of nonulcer dyspepsia are usually mild. Often the condition is treated by examining and changing your daily routines. This may include avoiding certain foods that seem to worsen symptoms, controlling stress, and changing or limiting daily medications or supplements. Some people find that having smaller but more frequent meals and eating low-fat foods also improves their symptoms.

If these practices don't help you, your doctor may recommend drug therapy. Many of the medications used to treat ulcers are recommended for nonulcer dyspepsia. At times, antibiotics are prescribed — some people with nonulcer dyspepsia test positive for H. pylori. Eradicating H. pylori, however, may not improve your symptoms. Other therapies that may be helpful include:

  • Pain relievers — Drugs that block pain or its perception may help desensitize nerves in your digestive system. Antidepressants often work well for irritable bowel syndrome, which some researchers believe may be associated with nonulcer dyspepsia. However, further study is needed to determine the value of antidepressant therapy.

  • Antispasmodic drugs — These drugs, including the prescription medications dicyclomine (Bentyl) and hyoscyamine (Levsin), help relax muscles in your digestive tract, but haven't shown much promise in treating nonulcer dyspepsia.

  • Behavior therapy — If your condition may be related to stress or a psychological disorder, you may see a psychiatrist, psychologist or nurse counselor. These health care professionals can help you control stress or deal with intense emotions that may be contributing to your symptoms.

Adapted from the book "Mayo Clinic on Digestive Health"

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