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Upset Stomach (Dyspepsia):
Stomach & Abdominal Pain

Indigestion, dyspepsia, stomach upset, constant stomach pain: These terms are often used interchangeably for a common disorder of the digestive system.

Upset stomach is usually a minor condition that responds well to treatment.

Symptoms of Indigestion

Always consult your doctor if you have any of the following symptoms associated with upset stomach:

heartburn
constant or intermittent abdominal pain
burning stomach pain in the upper and mid regions of the stomach
a queasy sensation
nausea and vomiting
chest pain
fullness, bloating
gassiness, flatulence
abdominal distension
stomach acid regurgitating into your mouth.

Common Causes of Upset Stomach

The most frequent cause of upset stomach is eating high-fat foods too quickly. Other common causes include:

eating too quickly
over-eating
a high-fat diet
high levels of stomach acid
acid reflux disease, where stomach acid is forced back up through the esophagus
medication such as NSAIDs used for treating other conditions
smoking
excess alcohol and/or caffeine consumption.

Other Causes of Abdominal Pain

Other possible causes of stomach upset include:

peptic ulcers: gastric and duodenal ulcers
cholecystitis: inflammation of the gallbladder (but typically only in conjunction with other gastrointestinal diseases)
cardiac ischemia: insufficient blood and oxygen flowing to the heart, with abdominal pain increasing after exercise
gastritis: inflammation of the stomach lining
pancreatitis: inflammation of the pancreas
stress: anxiety and/or depression.

What is Functional Dyspepsia?
Functional dyspepsia is the medical term for continuous stomach upset with no apparent cause.

Diagnosis and Treatment of Indigestion

Treatment for dyspepsia is often a process of elimination. First, your doctor checks whether you're taking any of the medications known to cause or aggravate an upset stomach.

Once dyspepsia has been diagnosed and the cause of stomach pain established, medication is usually prescribed to reduce the levels of acid produced by the stomach and to address the symptoms.

Treatment Options for Non-Specific Stomach Pain

Treatment for an upset stomach depends on the symptoms and the cause of abdominal pain. If, for instance, the abdominal pain is caused by the presence of stomach ulcers, treatment is likely to involve antacid medication. A stomach infection may require antibiotic drugs to eliminate bacteria such as H. pylori.

What if Symptoms of Upset Stomach Persist?

If symptoms persist following completion of the prescribed course of medication, or they change in any way, review the situation with your doctor who may advise additional diagnostic testing.

Symptoms such as weight loss or blood in the stools, in particular, must be investigated to rule out more serious diseases. Your doctor will probably schedule an endoscopy (fiber optic visualization of the stomach) in order to inspect the source of the abdominal pain and to determine appropriate treatment.

How to Prevent Upset Stomach

Simple preventive measures for dyspepsia include:

keeping a food diary and avoiding foods that tend to cause a flare-up of upset stomach
eating slowly and chewing well
quitting smoking
avoiding exercise after a large meal
not over-eating
avoiding heavy meals before bedtime
staying clear of anti-inflammatory medications such as aspirin and NSAIDs
trying to reduce or manage stress.

Did you know that . . .
. . . certain anti-inflammatory medicines like aspirin, ibuprofen, naproxen and ketoprofen may aggravate or cause upset stomach? Tell your doctor if you're taking any over-the-counter anti-inflammatory medications so you can switch to drugs that won't aggravate your condition.

Resources

American Academy of Family Physicians. (2005). Dyspepsia: What it is and what to do about it.

Beers, M.H. & Berkow, R. (ed). Functional dyspepsia.The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research Laboratories, NJ, 1999.

National Library of Medicine. (2005). Indigestion. MedlinePlus Medical Encyclopedia.

PDR Health. (2004). Heartburn and stomach pain: The latest remedies.