Gastrointestinal Pain Overview

Pain in the upper or lower stomach is a common and distressing problem. Fortunately, there are many non-surgical ways to treat it.

IBSIrritable bowel syndrome is a common cause of chronic stomach pain in the lower stomach. The two leading causes of chronic stomach pain are irritable bowel syndrome (IBS) in the lower stomach, and non-ulcer (or functional) dyspepsia in the upper stomach, according to Linda Nguyen, MD, Clinical Associate Professor of Medicine—Gastroenterology & Hepatology at Stanford Medical Center in Palo Alto, California.

Irritable bowel syndrome affects the colon (large intestine), causing abdominal pain, bloating, cramping, excessive gas, constipation and diarrhea. Some people with IBS have severe pain that can last for several days at a time, while others have pain that is less disabling and lasts for shorter periods. A person’s symptoms can vary from bout to bout of IBS.

While it is not known what causes IBS, it is thought that a number of factors may be involved, including diet, stress, hormones, genetic factors, inflammation, and alterations in gut microbiota that contribute to hypersensitive nerves in lining of the gut, and altered motility (a malfunctioning of the muscles) used to move food and waste through the body.

“While stress and anxiety don’t cause IBS, they can exacerbate the symptoms,” Dr. Nguyen says. “For instance, students with IBS may experience an increase in symptoms around midterms and finals.”

non-ulcer dyspepsiaAnother common cause of chronic stomach pain is non-ulcer dyspepsia which is typically felt in the upper stomach.Non-ulcer dyspepsia is upper stomach pain with no known cause such as an ulcer, or an inflamed esophagus or stomach. A person with the condition can feel bloated, nauseous and quickly feels full after eating.

While both conditions can occur at any age (including children), they are more commonly diagnosed in younger patients and women. “However, there is frequently a delay in the time onset of symptoms and the time patients are diagnosed,” Dr. Nguyen notes.


To diagnose non-ulcer dyspepsia or IBS, the doctor will ask about how you experience the pain, and where it occurs. You will receive a physical exam and be asked about your family medical history.

For non-ulcer dyspepsia, the doctor may order an endoscopy and ultrasound to rule out other possible causes of the pain, as well as a test to detect the H. pylori bacteria, which may cause similar symptoms.

To diagnose IBS, the doctor may order a blood test to check for conditions other than IBS. You may have a stool test, a flexible sigmoidoscopy or a colonoscopy. You may also get a lower GI series, also called a barium enema, to look at the large intestine.

“If a person has additional symptoms such as bleeding, fever, losing a significant amount of weight or symptoms that wake them at night, then we do additional testing to see if they have less common disorders such as Crohn’s disease or ulcerative colitis,” Dr. Nguygen says.


“Many people find their symptoms can be managed with diet,” Dr. Nguyen says. Patients with both conditions often benefit from a diet known as the FODMAP diet, which avoids foods that tend to cause stomach upset. (FODMAP is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols—foods that contain these molecules are not well absorbed by some people.)

“Studies have shown that people with IBS and functional dyspepsia who consume a low-FODMAP diet tend to have less severe symptoms than those who consume a regular diet,” she says.

The diet can be challenging to follow, Dr. Nguyen acknowledges. She recommends that patients starting the diet work with a nutritionist.

Common FODMAPs include:

  • Fructose: A simple sugar found in many fruits, vegetables and added sugars.
  • Lactose: A carbohydrate found in dairy products like milk.
  • Fructans: Found in many foods, including gluten grains like wheat, spelt, rye and barley.
  • Galactans: Found in large amounts in legumes.
  • Polyols: Sugar alcohols like xylitol, sorbitol, maltitol and mannitol. They are found in some fruits and vegetables, and often used as sweeteners.

In many cases, a person with stomach pain may be helped by making less drastic changes in their diet. Some people find relief by avoiding foods that cause flatulence, such as beans, broccoli, cauliflower, cucumbers, celery, onions, carrots, raisins, bananas, apricots, prunes, and Brussels sprouts.

“Many people who suffer from cramping with IBS or pain with functional dyspepsia find relief with peppermint in extracts, teas or capsules,” Dr. Nguyen says. Other beneficial complementary and alternative medicine that can help include acupuncture and herbs, such as a commercially-available blend of STW5 (sold as Iberogast).

Lifestyle changes that may reduce symptoms of both conditions include: eating regular meals, losing weight if you are obese, quitting smoking, and not drinking too much alcohol. Getting enough sleep is also very important, Dr. Nguyen tells her patients.

Therapies to reduce stress, including hypnosis, cognitive behavioral therapy and relaxation techniques, can be helpful in managing IBS and non-ulcer dyspepsia symptoms.

If dietary and lifestyle changes are not effective, your doctor may recommend medications. For IBS, the doctor may recommend therapies based on the predominant symptom: stool softeners, laxatives (if constipation) or medication that slows down the contractions of the intestinal muscles, such as loperamide (if diarrhea).

There are no medications on the market that are approved specifically to treat non-ulcer dyspepsia. Some doctors may prescribe:

  • Medications to decrease gastric acid
  • Antidepressants to decrease nerve pain such as duloxetine (Cymbalta) or tricyclic antidepressants
  • Medications that relax the stomach such as buspirone (Buspar)
  • Other medications used to treat nerve pain, such as gabapentin (Neurontin) or pregabalin (Lyrica)

She advises caution in treating stomach pain with opiates. “Even short-term use of opiates can worsen nerve hypersensitivity in the stomach, worsen constipation and slow stomach emptying,” she says.

“With both conditions, it’s not realistic to have a goal of zero pain,” Dr. Nguyen says. “It’s to make the pain more manageable, so patients have a better quality of life.”

Updated on: 03/05/19
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