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Non Ulcer Dyspepsia

Definition A type of indigestion or dyspepsia not caused by peptic ulcers. The symptoms are often similar to dyspepsia caused by ulcers such as bloating and upper abdominal pain or discomfort. Often there is no obvious cause for the discomfort but sometimes it may be result from eating too fast, overeating or eating while stressed. Symptoms The signs and symptoms of nonulcer stomach pain may include:

A burning sensation or discomfort in your upper abdomen or lower chest, sometimes relieved by food or antacids Bloating Belching Gas (flatulence) An early feeling of fullness with meals Nausea

What causes functional 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 functional 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 functional 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 functional 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. 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 medicines can cause dyspepsia. The most common culprits are anti-inflammatory medicines.

Treatment For Nonulcer Dyspepsia Your doctor will probably arrange for tests to exclude other digestive disorders. A blood test may be carried out to check for infection of the stomach lining from the bacterium H. pylori (herlicobacter pylori infection). Also, upper digestive tract endoscopy or contrast X-Rays may be carried out to look for abnormalities in the gastrointestinal tract. If no underlying disorder is found to cause your indigestion, you will be diagnosed with Nonulcer Dyspepsia. How To Prevent Indigestion - Self-Help Measures In order to help reduce both the frequency and severity of bouts of indigestion, follow these steps:

Eat small portions of food at regular intervals, without eating too fast or overfilling your stomach. Avoid eating in the three hours before going to bed to allow your body enough time to digest food. Reduce or eliminate your intake of alcohol, coffee and tea. Avoid rich, fatty foods such as butter and fried foods. Learn to overcome stress, which can often trigger episodes of abdominal discomfort. If overweight, try to reduce weight and avoid tight fitting clothing. If possible, avoid medicines that irritate the digestive tract, such as aspirin and other nonsteroidal anti-inflammatory drugs.

If these measures do not resolve the problem, your doctor may prescribe a drug to neutralize or reduce stomach acid production. There are also other drugs antispasmodic drugs and motility stimulants - that can help the stomach to empty more effectively, thus reducing this type of digestive complaint.

Tests and diagnosis


Your doctor will likely review your signs and symptoms and perform a physical examination. A number of diagnostic tests may help your doctor determine the cause of your discomfort. These may include:

Blood tests. Blood tests may help rule out other diseases that can cause signs and symptoms similar to those of nonulcer stomach pain. Stool tests. Your doctor may test a sample of your stool to look for a bacterium called Helicobacter pylori (H. pylori) that can cause stomach problems.

Using a scope to examine your digestive system. A thin, flexible, lighted instrument (endoscope) is passed down your throat so that your doctor can view your esophagus, stomach and the first part of your small intestine (duodenum).

Medications Medications that may help in managing the signs and symptoms of nonulcer stomach pain include:

Over-the-counter antacids. Antacids (Maalox, Mylanta, others) in liquid or tablet form are a common treatment for indigestion. Antacids neutralize stomach acid and can provide fast pain relief. Over-the-counter gas remedies. Drugs that contain the ingredient simethicone may provide some relief by reducing gas. Examples of gas-relieving remedies include Mylanta and Gas-X. Medications to reduce acid production. Called H-2-receptor blockers, these medications are available over-the-counter and include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac 75). Stronger versions of these medications are available in prescription form. Medications that block acid 'pumps.' Proton pump inhibitors shut down the acid "pumps" within acid-secreting stomach cells. Proton pump inhibitors reduce acid by blocking the action of these tiny pumps. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC). Stronger, prescription proton pump inhibitors also are available. Medication to strengthen the esophageal sphincter. Prokinetic agents help your stomach empty more rapidly and may help tighten the valve between your stomach and esophagus, reducing the likelihood of upper abdominal discomfort. Doctors may prescribe the medication metoclopramide (Reglan), but this drug may have significant side effects. Medications that control muscle spasms. Antispasmodic medications may help relieve stomach pain that's caused by spasms in the intestinal muscles. These medications include dicyclomine (Bentyl) and hyoscyamine (Levsin). Low-dose antidepressants. Tricyclic antidepressants and drugs known as selective serotonin reuptake inhibitors (SSRIs), taken in low doses, may help inhibit the activity of neurons that control intestinal pain. Your doctor may suggest antidepressants such as nortriptyline (Pamelor) and desipramine (Norpramin). SSRIs such as sertraline (Zoloft) or escitalopram (Lexapro) also may be helpful. Antibiotics. If tests indicate that a common ulcer-causing bacterium called H. pylori is present in your stomach, your doctor may recommend antibiotics. Antibiotics may also be used if tests reveal you have too much bacteria in your intestines.

Behavior therapy Working with a counselor or therapist may help relieve signs and symptoms that aren't helped by medications. A counselor or therapist can teach you relaxation techniques that

may help you cope with your signs and symptoms. You may also learn ways to reduce stress in your life in order to prevent nonulcer stomach pain from recurring.

Lifestyle and home remedies


By Mayo Clinic staff Your doctor may recommend lifestyle changes to help you control your nonulcer stomach pain. Make changes to your diet Changes to your diet and how you eat might help control your signs and symptoms. Consider trying to:

Eat smaller, more-frequent meals. Having an empty stomach can sometimes produce nonulcer stomach pain. Nothing but acid in your stomach may make you feel sick. Try eating a small snack, such as a cracker or a piece of fruit. Avoid skipping meals. Avoid large meals and overeating. Eat smaller meals more frequently. Avoid trigger foods. Some foods may trigger nonulcer stomach pain, such as fatty and spicy foods, carbonated beverages, caffeine and alcohol. Chew your food slowly and thoroughly. Allow time for leisurely meals. Take steps to avoid excessive air. To reduce excess gas and belching, refrain from activities that result in excessive air swallowing, such as smoking, eating rapidly, chewing gum, drinking through a straw and drinking carbonated beverages. Stay upright after a meal. Wait to lie down until at least two hours after eating.

Reduce stress in your daily life Stress-reduction techniques may help you control your signs and symptoms. To reduce stress, try to:

Identify current stressors in your life. Learn how to manage your stress. Exercising, if your doctor confirms that it's safe for you, and listening to soothing music may help. Learn and practice relaxation techniques. These may include relaxed breathing, meditation, yoga and progressive muscle relaxation. Pursue relaxing activities. Spend time doing things you enjoy, such as hobbies or sports.

Exercise most days of the week Exercise may help you control your signs and symptoms. As you get started, try to:

Talk to your doctor. Get your doctor's advice before beginning a new exercise routine. Take it easy at first. Start your exercise program gradually.

Get regular physical activity. Aim for at least 30 to 60 minutes of physical activity on most days of the week to achieve and maintain a healthy weight and reduce your risk of many chronic diseases. Don't exercise immediately after eating. Give your stomach time to settle.

Intestinal obstruction Definition


Intestinal obstruction is a blockage of your small intestine or colon that prevents food and fluid from passing through. Intestinal obstruction can be caused by many conditions, including fibrous bands of tissue in the abdomen (adhesions), hernias and tumors. Intestinal obstruction can result in an array of uncomfortable signs and symptoms, including abdominal pain and swelling, nausea, and vomiting. If left untreated, intestinal obstruction can cause the blocked parts of your intestine to die. This tissue death can lead to perforation of the intestine, severe infection and shock. However, with prompt medical care, intestinal obstruction can often be successfully treated.

Symptoms
Signs and symptoms of intestinal obstruction include:

Crampy abdominal pain that comes and goes Nausea Vomiting Diarrhea Constipation Inability to have a bowel movement or pass gas Swelling of the abdomen (distention)

When to see a doctor Because of the serious complications that can develop from intestinal obstruction, seek immediate medical care if you develop the signs or symptoms listed above.

Causes
Many conditions can cause intestinal obstruction. Intestinal obstruction can occur as the result of a "mechanical" obstruction when something, such as a hernia or tumor, is physically blocking your intestine. Or intestinal obstruction can occur as the result of a condition in which your intestines don't function properly. This type of intestinal obstruction is called paralytic ileus (pseudo-obstruction). Mechanical obstruction of the small intestine Common causes of mechanical obstruction in the small intestine include:

Intestinal adhesions bands of fibrous tissue in the abdominal cavity that often form after abdominal or pelvic surgery Hernias portions of intestine that protrude into another part of your body Tumors in the small intestine Inflammatory bowel diseases, such as Crohn's disease Twisting of the intestine (volvulus) Telescoping of the intestine (intussusception)

Mechanical obstruction of the colon Mechanical intestinal obstruction is much less common in the colon than in the small intestine. Causes of mechanical colonic obstruction can include:

Colon cancer Diverticulitis a condition in which small, bulging pouches (diverticula) in the digestive tract become inflamed or infected Twisting of the colon (volvulus) Impacted feces Narrowing of the colon caused by inflammation and scarring (stricture)

Paralytic ileus Paralytic ileus can cause signs and symptoms of intestinal obstruction, but doesn't involve an actual obstruction. In paralytic ileus, the intestines don't function properly due to muscle or nerve problems. Movement of the intestines is greatly reduced or absent, making it difficult for food and fluid to flow smoothly through the digestive system. Paralytic ileus can affect any part of the intestine. Causes can include:

Abdominal surgery Pelvic surgery Infection Certain medications Muscle and nerve disorders, such as Parkinson's disease

Risk factors
Diseases and conditions that can increase your risk of intestinal obstruction include:

Abdominal or pelvic surgery, which often causes adhesions a common cause of intestinal obstruction Crohn's disease an inflammatory condition that can cause the intestine's walls to thicken, narrowing its passageway Cancer within your abdomen, especially if you've had surgery to remove an abdominal tumor or radiation therapy

Complications
f left untreated, intestinal obstruction can cause serious, life-threatening complications, including:

Death of the affected intestine. Intestinal obstruction can cut off the blood supply to the affected portion of your intestine. If left untreated, lack of blood causes the intestinal wall to die. Tissue death can result in a tear (perforation) in the intestinal wall, which can lead to infection. Infection in the abdominal cavity. Peritonitis is the medical term for infection in the abdominal cavity. It's a life-threatening condition that requires immediate medical and surgical attention.

Tests and diagnosis


Tests and procedures used to diagnose intestinal obstruction include:

Physical exam. Your doctor will ask about your medical history and your symptoms. He or she will also do a physical exam to assess your situation. The doctor may suspect intestinal obstruction if your abdomen is swollen or tender or if there's a lump in your abdomen. Imaging tests. To confirm a diagnosis of intestinal obstruction, your doctor may recommend abdominal X-ray or computerized tomography (CT) scans. These tests also help your doctor determine if the obstruction is paralytic ileus or if it's a mechanical obstruction, and if it's a partial or a complete obstruction.

Treatments and drugs


Treatment for intestinal obstruction depends on the cause of your condition. Hospitalization to stabilize your condition Treatment for intestinal obstruction requires hospitalization. When you arrive at the hospital, the doctors will first work to reverse your medical condition and stabilize you so that you can undergo treatment. This may include:

Placing an intravenous (IV) line into a vein in your arm so that fluids can be given Putting a nasogastric (NG) tube through your nose and into your stomach to suck air and fluid out to relieve abdominal swelling Placing a thin, flexible tube (catheter) into your bladder to drain urine and collect it for testing

Treatment for a partial mechanical obstruction If you have mechanical obstruction in which some food and fluid can still get through (partial obstruction), you may recover after you've been stabilized in the hospital. You may not require further treatment. Your doctor may also recommend a special low-fiber

diet that is easier for your partially blocked intestine to process. If the obstruction does not clear on its own, you may need surgery to relieve the obstruction. Treatment for a complete mechanical obstruction Complete obstruction, in which nothing can pass through your intestine, usually requires surgery to relieve the blockage. The procedure you undergo will depend on what's causing the obstruction and which part of your intestine is affected. Surgery typically involves removing the obstruction, as well as any section of your intestine that has died. Treatment for paralytic ileus If your doctor determines that your signs and symptoms are caused by paralytic ileus, he or she may monitor your condition for a day or two in the hospital. Paralytic ileus is often a temporary condition that gets better on its own. If paralytic ileus doesn't improve within several days, your doctor may prescribe medication that causes muscle contractions, which can help move food and fluids through your intestines.