Medical Today

Definition

Stomachache is pain or discomfort in the stomach that is a symptom of many different gastrointestinal diseases or conditions.

Description

Stomachache, also called dyspepsia, is a symptom of an underlying disease or condition of the gastrointestinal system. Stomachache is defined as pain or discomfort in the upper abdomen. Discomfort refers to any negative feeling including fullness, bloating, or early satiety (quenched thirst or appetite).

Dyspepsia accounts for 2–5% of all visits to a physician. Unfortunately, no cause is found for 30–60% of patients with dyspepsia. When no cause is found, the disorder is termed non-ulcer dyspepsia. Several factors may lead to non-ulcer dyspepsia. Delayed emptying of the stomach contents and stomach and intestinal rhythmic movement (motility) disorders can lead to dyspepsia.

Some persons have lower sensory thresholds for stomach distension and more readily experience stomachache. Abnormal release of stomach acids may also be associated with dyspepsia.

Studies performed around the world have determined that between 7–41% of the population suffer from dyspepsia. This wide variation is most likely due to differences in study methods, not differences in the prevalence of dyspepsia.

Causes & symptoms

The occasional stomachache is usually caused by overeating, stomach gas, eating foods that do not agree with a person’s digestive system, drinking too much alcohol, food poisoning, or gastrointestinal infection.

Obesity places extra pressure on the stomach that can cause pain. Smoking increases stomach acid production and relaxes the valve between the stomach and the esophagus, both of which can cause stomach pain. Because there are many causes of dyspepsia, physicians try to fit each case into one of five categories based upon the set of symptoms. Nonulcer dyspepsia refers to long-term or recurrent pain in the upper abdomen that has no identified structural cause. Ulcer-like dyspepsia refers to abdominal pain with three or more of the following symptoms: well-localized pain, pain relieved by eating, pain relieved by antacids, pain occurring when hungry, pain that disrupts sleep, or pain that comes and goes for at least two week intervals. Dysmotility-like dyspepsiarefers to upper abdominal discomfort, not pain, with three or more of the following: early satiety, nausea, fullness after eating, recurrent retching or vomiting, bloating, or abdominal discomfort worsened by food. Reflux-like dyspepsia is stomach pain accompanied by heartburn.

Nonspecific dyspepsia refers to patients whose symptoms do not fit into the other categories.

Specific causes of stomachaches include:

• Biliary tract disease, disorders of the gallbladder, bile, and bile ducts. Biliary pain is a severe persistent pain in the upper middle or upper right region of the abdomen.

• Drug-induced dyspepsia, which may be caused by digitalis, theophylline, antibiotics, and iron or potassium supplements.

• Dysmotility disorders, gastrointestinal motility that is either too fast or too slow, and may lead to abdominal pain.

• Gastric cancer, although a rare cause of stomachache, needs to be considered in the differential diagnosis because of the seriousness of the disease.

• Gastroesophageal reflux causes a burning pain or discomfort that travels up to the throat. This common disorder affects up to 50% of adults.

• Irritable bowel syndrome, a chronic disease characterized by abdominal pain and changes in bowel functioning (diarrhea and/or constipation).

• Pancreatic disease, including pancreatitis (inflammation of the pancreas) and pancreatic cancer, can cause severe persistent pain that may travel to the back.

• Peptic ulcer refers to any ulcer (a defect or hole) of the upper digestive tract.

• Such psychiatric disorders as depression, panic disorder, and eating disorders can lead to stomach pains.

• Other disorders. Stomachaches may be caused by diabetes mellitus, hypothyroidism, hypercalcemia, ischemic heart disease, intestinal angina, certain cancers, Crohn’s disease, tuberculosis, and syphilis. In addition, abdominal muscle strain, myositis, and nerve entrapment can cause abdominal pain which could be confused with dyspepsia.

Stomachache itself is a discomfort or pain in the upper abdomen. The patient may experience other symptoms as well, depending upon the cause of the stomachache. Stomachache must be experienced for three months to be considered chronic (long-term). Persons who experience recurrent vomiting, weight loss, dysphagia (swallowing difficulty), or bleeding should seek prompt medical attention.

Diagnosis

Stomachache may be diagnosed by an internal medicine specialist or a gastroenterologist. Because diagnosing dyspepsia can be time consuming and expensive, all attempts are made to first rule out a structural cause of the pain to prevent the use of unnecessary tests. The diagnostic process would include a thorough medical history and physical examination.

The presence of Helicobacter pylori, a common cause of ulcers, in the stomach, would be determined. There is a higher risk for structural disease in persons older than 45 years; therefore, these persons would undergo upper gastrointestinal endoscopy (upper GI). Endoscopy is the use of a wand-like camera to visualize internal organs, including the stomach and intestinal tract.

If ulcer has been ruled out, then an upper GI (an xray study of the upper GI tract) and several blood tests would be performed. Ultrasound (visualization of internal organs using sound waves) may be performed to view the liver, pancreas, and gall bladder. More specific tests that may be conducted include lactose tolerance test, stomach-emptying study, gastroduodenal manometry (measures pressure and motility of the stomach and small intestine), electrogastrography (measures electrical activity of the stomach), and esophageal pH testing (measures the pH in the pipe running from the throat to the stomach).

Treatment

Stomachaches may be treated with over the counter antacids (Tums, Pepto-Bismol) and anti-gas products (Gas-X). An H. pylori infection is treated with a combination of tetracycline, bismuth subsalicylate (Pepto-Bismol), and metronidazole (Metizol). Non-ulcer dyspepsia may be treated with the proton pump inhibitors omeprazole (Prilosec) and lansoprazole (Prevacid); the H2 receptor antagonists ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid); or the prokinetic drug cisapride.

Stomachaches that are caused by diseases such as cancer, diabetes, pancreatitis, etc. would be treated using the specific medications and procedures recommended for the particular disease.

Expected results

Stomachaches may resolve spontaneously. Medical treatment of stomachaches can relieve symptoms temporarily but a cure is not expected.