Stomachaches

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 nonulcer dyspepsia. Several factors may lead to nonulcer 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 dyspepsia refers 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

Alternative remedies can be effective in treating stomachache and associated digestive symptoms. Persons who experience chronic, unexplained stomach pain should consult a physician.

Herbals

The following herbal remedies help treat stomachaches:

• agave (Agave americana ) tincture
• asafoetida (Ferula asafoetida ) tincture
• cumin (Cumin cyminum ) seed poultice

When gas is the reason for discomfort, these herbals can be used:

• angelica (Angelica archangelica ) infusion
• anise (Pimpinella anisum ) infusion
• catnip (Nepeta cataria ) tea
• oatstraw (Avena sativa ) tea

Indigestion accompanied by gas or due to increased stomach acid production can be soothed by the following herbals:

• arrowroot (Maranta arundinacea ) infusion
• calendula (Calendula officinalis ) and comfrey root tea
• cardamom (Elettaria cardamomum ) powder
• fennel (Foeniculum vulgare ) infusion
• galbanum (Ferula gummosa ) infusion: acid indigestion
• Iceland moss (Cetraria islandica ) infusion
• marsh mallow (Althaea officinalis ) tea
• meadowsweet (Filipendula ulmaria ) tea
• slippery elm (Ulmus fulva ) powder or tea

Other disorders causing stomach pain and discomfort can be relieved with these herbals:

• Asian red ginseng (Panax ginseng ) tea or tincture: stomach pain and bloating
• chamomile (Chamomilla recutita ) tea: upset stomach, gas, and stomach spasm
• crab apple (flower remedy): stomachaches caused by bad food
• crampbark (Viburnum opulus ) infusion: stomach spasm
• dandelion (Taraxacum officinale ) root tea or tincture: heartburn, stomachache, and gas
• elderberry (Sambucus nigra ) tea: stomach pain
• ginger (Zingiber officinale ) raw or tea
• lemon balm (Melissa officinalis ) tea: stomach spasm, gas, and bloating
• licorice (Glycyrrhiza glabra ) root tea or tincture: heartburn and acid reflux
• peppermint (Mentha piperita ) tea: upset stomach, gas, and stomach spasm
• thyme (Thymus vulgaris ) tea: upset stomach

Homeopathy

Homeopathic remedies are chosen based upon the specific set of symptoms displayed by the patient. Bryonia is indicated for stomach pain that is worsened by motion. Colocynthis or Magnesia phosphorica is recommended for pain that is relieved by doubling up. Cuprum is indicated for violent, cramping pain. Dioscorea is chosen for pain that is lessened by standing up and worsened by doubling up. Lycopodium is indicated for persons who get bloated after eating or whose pain is worsened by pressure. Magnesia phosphorica is recommended for pain that is relieved by pressure. Nux vomica is indicated for stomach pain that occurs after eating rich or spicy foods or too much alcohol. Pulsatilla is chosen for persons who experience digestive symptoms after eating fatty foods.

Chinese medicine

Traditional Chinese medicine (TCM) treats stomachaches with acupuncture , ear acupuncture, cupping , herbs, and patent medicines. Common syndromes that cause abdominal pain include: Damp-heat stagnation, retention of cold, retention of food, deficiency and coldness of Zang Fu, and stagnation of qi and blood.

Abdominal pain caused by deficiency and cold is treated with Fu Zi Li Zhong Wan (prepared Aconite pill to regulate the middle). Abdominal pain caused by cold is treated with Liang Fu Wan (Galagal and Cyperus pill). All causes of abdominal pain (except damp-heat) may be treated with a mixture of Yan Hu Suo (Rhizoma corydalis ), Chen Xiang (Lignum aquilariae resinatum ), and Rou Gui (Cortex cinnamomi ).

Ayurveda

Ayurvedic practitioners believe that indigestion is due to weak or insufficient agni (digestive fire). To enhance digestion, the patient can take fresh ginger; a mixture of garlic powder (one quarter teaspoon), trikatu (one half teaspoon), and rock salt (pinch); or a mixture of garlic (one clove), cumin powder (one quarter teaspoon), rocksalt (pinch), trikatu (pinch), and lime juice (one teaspoon) before meals. Bay leaf tea drunk after meals can enliven agni. Digestion may be enhanced with Shatavari or Teak tree (Tectona grandis ) wood or bark.

Chronic indigestion and stomachaches may be relieved by taking a mixture of trikatu (one part), chitrak (two parts), and kutki (one part) with honey and ginger juice before meals. Common stomachaches may be relieved by taking a shankavati or lasunadivati pill twice daily; ajwan (one half teaspoon) and baking soda (one quarter teaspoon) in water; a mixture of cumin powder (one third teaspoon), asafetida (pinch), and rock salt (pinch) in water; or chewing one half teaspoon of roasted fennel, cumin, and coriander seeds.

Other treatments

Other treatments for stomachaches are:

• Acupressure. Pressing both Sp 16 points (located below the bottom of the rib cage) can relieve stomachaches.
• Aromatherapy. Sucking on a sugar cube containing one drop of the essential oil of peppermint can ease stomachaches. Taking honey containing one drop of essential oil of tarragon, marjoram, or rosemary reduces digestive tract spasms.
• Hydrotherapy. Stomachache can be relieved by drinking water containing activated charcoal powder. A hot water bottle or hot compress placed over the abdomen can help relieve stomach pains.
• Juice therapy. Digestion can be improved and gas dispelled by drinking fresh apple juice with mint, fennel, and ginger.

Allopathic treatment

Stomachaches may be treated with over the counter antacids (Tums, Pepto-Bismol) and antigas products (Gas-X). An H. pylori infection is treated with a combination of tetracycline, bismuth subsalicylate (Pepto-Bismol), and metronidazole (Metizol). Nonulcer 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.

Prevention

Common stomachaches can be prevented by avoiding the following: overeating, excessive alcohol consumption, problem foods, and smoking. Stomachaches may be prevented by enhancing digestion by taking fresh ginger or Draksha (Ayurvedic herbal wine) before meals. Ginger or bay leaf tea or lassi (yogurt with cumin and ginger powders in water) taken after meals can aid digestion and prevent stomachaches. Drinking warm drinks during meals aids digestion as does chewing food thoroughly. Persons should eat only when hungry and leave space in the stomach for proper digestion. Obesity can increase problems like reflux, and a 2001 study found a strong connection between obesity and severity of reflux.

Resources

BOOKS

Reichenberg-Ullman, Judyth, and Robert Ullman. Homeopathic Self-Care: The Quick and Easy Guide for the Whole Family. Rocklin, CA: Prima Publishing, 1997.

Talley, Nicholas J., and Gerald Holtmann. "Approach to the Patient With Dyspepsia and Related Functional Gastrointestinal Complaints." Textbook of Gastroenterology. 3rd ed. Edited by Tadataka Yamada, et al. Philadelphia: Lippincott Williams & Wilkins, 1999.

Ying, Zhou Zhong, and Jin Hui De. "Abdominal Pain." Clinical Manual of Chinese Herbal Medicine and Acupuncture. New York: Churchill Livingston, 1997.

PERIODICALS

Cavalli, Ellen. "Relief for Holiday Pigouts." Vegetarian Times (November 1999): 94+.

"Fast Lives Bring on the Burn." Chemist and Druggist (November 10, 2001): 37.

Levine, Beth. "How to Treat Any Kind of Tummyache." Red-book 190 (April 1998): 145+.

Sullivan, Karin Horgan. "Oh, What a Relief it is: Herbs to Soothe an Upset Stomach." Vegetarian Times (November 1996): 94+.

Wajed, Shahjehan A. "Elevated Body Mass Disrupts the Barrier to Gastroesophageal Reflux." The Journal of the American Medical Association (December 5, 2001): 2650.

ORGANIZATIONS

The American Gastroenterological Association (AGA). 7910 Woodmont Ave., 7th Floor, Bethesda, MD 20814. (310) 654-2055. <http://www.gastro.org/index.html>.

Belinda Rowland

Teresa G. Odle