Irritable stomach

Tanja Unterberger studied journalism and communication science in Vienna. In 2015 she started her work as a medical editor at in Austria. In addition to writing specialist texts, magazine articles and news, the journalist also has experience in podcasting and video production.

More about the experts All content is checked by medical journalists.

Doctors refer to recurring or chronic symptoms in the upper abdomen as irritable stomach (functional dyspepsia). Sufferers report discomfort, pain and pressure in the abdomen or a feeling of fullness in the stomach. In the absence of organic causes, doctors make the diagnosis using a process of elimination. You can read more about symptoms as well as the course and treatment of irritable stomach here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. K30

Brief overview

What is an irritable stomach? Recurring or chronic complaints in the upper abdominal area without a recognizable organic cause are referred to as irritable stomachs.
Symptoms: Complaints that vary widely from person to person, such as pain in the upper abdomen, malaise, feeling of fullness, heartburn, loss of appetite, heart pounding.
Is an irritable stomach curable? Often the symptoms do not go away completely, but they can be significantly alleviated.
Frequency: around 20 percent of the population is affected each year.
Causes: The exact cause of functional dyspepsia is unknown. Suspected factors include a lack of gastric mobility and increased sensitivity of the gastric nerves.
Diagnostics: The doctor uses various examinations to rule out other diseases.
Treatment: In the case of an irritable stomach, the therapy focuses on alleviating the symptoms (e.g. through diet adjustment, medication, lifestyle changes).
Prevention: stress reduction, regular exercise

What is an irritable stomach?

An irritable stomach (RM) is a functional digestive disorder - also called functional dyspepsia or irritable stomach syndrome (RMS). The term describes a number of different complaints of the upper abdomen that have no organic causes. This means that there are physical complaints, but no physical cause such as inflammation can be determined. Around 20 percent of the population are more or less frequently affected by symptoms of an irritable stomach a year. In many cases the symptoms are chronic. An irritable stomach is basically not dangerous, but it can seriously impair the quality of life.

What are the symptoms of an irritable stomach?

The symptoms of an irritable stomach vary greatly from person to person. Those affected often consult their doctor because of "indigestion", a "nervous stomach" or upper abdominal discomfort.

The following complaints can occur in various forms with an irritable stomach:

malaise
Belt-like or vague pain in the upper abdomen
Feeling of pressure in the stomach
Bloating
Quick feeling of satiety
Nausea and vomiting
heartburn
Acid eructation
Loss of appetite and sudden aversion to certain foods (e.g. alcohol, coffee, high-fat foods, sugar)
Stool irregularities (e.g. diarrhea)
Gas (flatulence), bloated stomach (meteorism)
Vegetative complaints such as circulatory problems, palpitations, heart stumbling, increased sweating

It is typical for an irritable stomach that the pain in the upper abdomen persists or recurs and has occurred at least three times a week for more than three months in the past six months. In addition, the symptoms do not improve after a bowel movement.

On the basis of certain criteria (Rome IV criteria), doctors differentiate between two types of functional dyspepsia, which can, however, also exist at the same time:

Epigastric Pain Syndrome (EPS): Here, pain and burning in the upper abdomen occur independently of meals.
Postprandial Distress Syndrome (PDS): This leads to a feeling of fullness, nausea and a premature feeling of fullness after eating.

All of these symptoms can be an irritable stomach, but a physical cause is also possible. Therefore, consult a doctor if your upper abdominal symptoms persist over a long period of time. With the help of various examinations, he rules out other diseases (differential diagnosis).

Irritable stomach or irritable bowel?

Both the irritable stomach and the irritable bowel are functional digestive disorders. They are among the most common digestive disorders. Typical of irritable bowel syndrome are pain in the middle / lower abdomen and alternating diarrhea and constipation. Those affected also report flatulence and excrete mucus when using the toilet.

40 percent of the time, people with nervous stomachs have irritable bowel symptoms at the same time. Conversely, people with irritable bowel syndrome also report symptoms that are attributed to an irritable stomach. With both symptoms, additional symptoms can occur that are not related to the abdominal cavity, such as headaches, sleep disorders, bone and joint problems.

Since similar causes are discussed for irritable stomach and irritable bowel syndrome, doctors assume that they are related and often occur together. In some cases, functional dyspepsia occurs together with reflux symptoms.This causes gastric juice to flow back into the esophagus.

Is an irritable stomach curable?

Functional dyspepsia is uncomfortable but harmless. Usually there are no complications or secondary diseases. However, an irritable stomach is usually chronic. Only every fifth person affected becomes completely symptom-free again. However, the symptoms can be significantly reduced by treatment.

Is an irritable stomach dangerous?

Basically, a nervous stomach is not dangerous. However, the recurring complaints can have a strong impact on everyday life. See a doctor if your symptoms persist, are particularly painful, or occur frequently overall. Serious illnesses can also be concealed behind it.

Warning: See a doctor as soon as possible if:

Unintentional weight loss
Recurrent vomiting
Severe, persistent stomach pain
Difficulty swallowing (dysphagia)
Vomiting blood (hematemesis)
Blood in the stool
Hard stomach
Enlarged lymph nodes

How long does an irritable stomach last?

The symptoms of an irritable stomach usually last for a long time (at least three months continuously or repeatedly for several days). In some cases, they even last for years. With various treatments, however, the symptoms usually improve significantly.

How does an irritable stomach occur?

So far it is not clear how an irritable stomach develops, because there is no recognizable physical cause. However, doctors assume that several factors play a role in its development. This includes:

Disturbed digestive processes: It is possible that the stomach and small intestine muscles do not work together properly in an irritable stomach. As a result, the stomach empties slowly (in 30 to 80 percent of those affected), but sometimes also unusually quickly. The cause of the pain may be an oversensitivity of the nerves of the gastrointestinal tract (visceral hypersensitivity) or an increased perception of pain.
Mental stress: In addition to functional dyspepsia, some sufferers have anxiety, neuroses, or depression. Some patients worry about a serious illness. This in turn can aggravate the irritable stomach symptoms.
Infection with Helicobacter bacteria (H. pylori): The role of the Helicobacter pylori bacterium in an irritable stomach has not yet been fully clarified. After an infection, H. pylori lodges in the gastric mucosa, but does not necessarily cause symptoms there. However, it can cause stomach disorders, such as stomach and duodenal ulcers or inflammation of the lining of the stomach (gastritis). A direct link between Helicobacter pylori and an irritable stomach has not been proven, but some patients with functional dyspepsia also have gastritis caused by H. pylori.
Disrupted function of the microbiome: The microbiome is the complete genetic information of the microorganisms living on and in the body. The intestinal microbiome with the intestinal bacteria not only plays an important role in digestion, but also in maintaining health. Doctors suspect that the irritable stomach could be due to a disrupted composition or function of the microbiome.
Medicines such as calcium channel blockers, bisphosphonates, iron supplements, corticosteroids, estrogens or certain antibiotics are discussed as the cause of irritable stomach symptoms.

How do you recognize an irritable stomach?

The diagnosis of irritable stomach is a diagnosis of exclusion (differential diagnosis). The doctor first rules out other diseases that cause similar complaints. These include, for example, gastric mucosal inflammation, stomach ulcers, malignant tumors of the stomach and esophagus (stomach cancer, esophageal cancer), diseases of the biliary tract, liver or intestine. The first point of contact for irritable stomach complaints is the family doctor. If necessary, he will refer the patient to a specialist in gastrointestinal diseases (gastroenterologist).

anamnese

At the beginning of the diagnosis there is a detailed discussion with the patient. A precise description (type, duration and severity) of the symptoms gives the doctor initial indications of functional dyspepsia.

Clinical examination

During the subsequent physical examination, the doctor palpates the abdomen, among other things. If he does not find any pathological changes in the gastrointestinal tract, the suspicion of functional dyspepsia is reinforced.

Further investigations

To make sure that it is not another disease with symptoms similar to those of the irritable stomach, the doctor examines the patient further as necessary. With the help of a blood test, you can determine, among other things, whether inflammation levels are increased, which suggest a physical cause such as gastritis. A stool examination is also useful to rule out organic causes.

For further diagnosis, doctors use an ultrasound examination (sonography) of the gastrointestinal tract. In the esophago-gastro-duodenoscopy (EGD), you examine the esophagus, the stomach and the initial part of the intestine with an endoscope. This is how they recognize stomach ulcers, for example. If necessary, doctors take tissue samples during this examination and examine them for the presence of the bacterium Helicobacter pylori. Further tests are possible to rule out food intolerance (e.g. lactose intolerance, fructose intolerance or histamine intolerance).

In around a quarter of the patients examined, organic causes, such as gastritis or reflux disease, can be determined through careful clarification of the symptoms. Three quarters of those affected are diagnosed with "irritable stomach" due to inconspicuous examination results.

Symptom diary

In order to get a better impression of the symptoms that burden the patient the most, doctors recommend keeping a symptom diary including a nutrition log for a few weeks. Those affected enter the following points, among other things:

Complaints that arise
Time and strength of occurrence
All meals and their respective amounts
Other special features
General living conditions

What can you do about an irritable stomach?

A first important step in the treatment of the irritable stomach is that the doctor informs the patient: What is the disease? What causes it? What does the therapy look like? What can i do on my own?

Because as differently as the symptoms of an irritable stomach express themselves from person to person, the corresponding therapy is just as individual. Since no specific cause is treated in functional dyspepsia, treatment aims to alleviate the symptoms.

Diet for irritable stomachs

There is no general nutrition or diet recommendation for an irritable stomach. It is best for everyone concerned to find out for themselves what is good for them and what is not by carefully trying them out. Not only the food itself plays a role, but also the way it is prepared.

It helps some patients to change their diet and lifestyle:

Avoid very spicy, sweet, spicy, very cold or hot foods.
Spread your meals out throughout the day: Several small servings may be better than a few large ones.
It is best not to get distracted while eating. Choose a quiet place and allow enough time for your meals.
Refrain from smoking and alcohol.
Eat a healthy, balanced diet and get enough exercise to avoid obesity.

In addition to the diet, permanent physical or emotional stress promotes the typical irritable stomach symptoms. So try to change your lifestyle habits to reduce stress. For example, try out exercises for relaxation such as autogenic training, yoga or progressive muscle relaxation, and plan conscious recovery phases in everyday life. Regular exercise also helps reduce stress. Psychotherapy is advisable for accompanying psychological complaints such as anxiety or depression.

Home remedies for an irritable stomach

Some sufferers use home remedies for their irritable stomach ailments. Even if their effect has not been scientifically proven, they are often beneficial and alleviate some ailments. Try out which home remedy will help you:

Warmth is often beneficial for stomach pains and cramps. A hot water bottle or a warm cherry stone pillow stimulate blood circulation and relax cramped muscles.
A gentle stomach massage (e.g. with chamomile oil) also contributes to relaxation and relieves the irritable stomach.
A warm tea is beneficial for pain in the upper abdomen and indigestion. Medicinal plants such as chamomile, fennel, peppermint, lemon balm and caraway can relieve stomach discomfort.

Caution: Home remedies do not replace treatment by a doctor. If your symptoms persist or even worsen, please consult your doctor.

Medication

The following drugs are currently used for an irritable stomach:

Prokinetics (metoclopramide, domperidone)

They support the movement (motility) of the stomach and thereby accelerate its emptying. However, due to possible side effects, it is recommended not to use them for more than six to eight weeks.

Acid suppressive therapies (proton pump inhibitors, H2 blockers)

For many people, these drugs relieve symptoms by reducing the amount of acid in the stomach.

Tricyclic antidepressants

If the aforementioned active ingredients are unsatisfactory, tricyclic antidepressants can help improve the quality of life despite an irritable stomach.

Phytotherapeutic agents

A positive effect of herbal therapeutic agents (such as peppermint and caraway) has been found in the latest studies on irritable stomach symptoms.

Helicobacter pylori eradication therapy

The H. pylori bacterium can be eliminated with antibiotics (eradication therapy). Whether this treatment also improves the symptoms of functional dyspepsia is currently still the subject of scientific studies. According to the current state of knowledge, every tenth person is symptom-free afterwards.

Tags: gpp healthy feet organ systems