Non-ulcer dyspepsia causes pain and sometimes other symptoms in your upper abdomen. The cause is often not clear. Medication to reduce stomach acid helps in some cases. Infection with H. pylori may cause a small number of cases. Clearing this infection, if present, helps in some people.
Food passes down the oesophagus (gullet) into the stomach. The stomach makes acid which is not essential, but helps, to digest food. Food then passes gradually into the duodenum (the first part of the small intestine).
In the duodenum and the rest of the small intestine, food mixes with enzymes (chemicals). The enzymes come from the pancreas and from cells lining the intestine. The enzymes break down (digest) the food. Digested food is then absorbed into the body from the small intestine.
Dyspepsia is a term which includes a group of symptoms that come from a problem in your upper gut. The gut (gastrointestinal tract) is the tube that starts at the mouth, and ends at the anus. The upper gut includes the oesophagus, stomach, and duodenum.
The main symptom of dyspepsia is usually pain or discomfort in the upper abdomen. In addition, other symptoms that may also develop include: heartburn (a burning sensation felt in the lower chest area), bloating, belching, quickly feeling full after eating, feeling sick (nausea) or vomiting. Symptoms are often related to eating.
Symptoms tend to occur in bouts which come and go, rather than being present all the time. However, some people have frequent bouts of dyspepsia which affect quality of life.
Non-ulcer dyspepsia is sometimes called functional dyspepsia. It means that no known cause can be found for the symptoms. That is, other causes for dyspepsia such as duodenal ulcer, stomach ulcer, oesophagitis (inflamed oesophagus), gastritis (inflamed stomach), etc, are not the cause. The inside of your gut looks normal (if you have an endoscopy - see below). It is the most common cause of dyspepsia. About 6 in 10 people who have recurring bouts of dyspepsia have non-ulcer 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:
Strictly speaking, non-ulcer dyspepsia is a diagnosis that is made only when no other cause can be found for the symptoms (such as an ulcer). Therefore, prior to the diagnosis being made you may have had an endoscopy. In this test a doctor looks inside your stomach and duodenum by passing a thin, flexible telescope down your oesophagus. If you have non-ulcer dyspepsia, the inside of your gut looks normal. However, most people with dyspepsia do not have an endoscopy. See separate leaflet called 'Dyspepsia (Indigestion)' for an overview of dyspepsia, and when tests are advised.
A test to detect the H. pylori bacterium may be done. If H. pylori is found then it may be causing the symptoms. See separate leaflet called 'Helicobacter Pylori and Stomach Pain' for more details about H. pylori and how it can be diagnosed and treated. Briefly, it can be detected in a sample of faeces (bowel motions), or in a breath test, or from a blood test, or from a biopsy sample taken during an endoscopy.
This is often helpful. Some people worry that they may have a serious disease such as stomach cancer. Worry and anxiety can make symptoms worse. It may be useful to know that you have non-ulcer dyspepsia, and not some other disease. However, you will have to accept that pain, discomfort and other dyspeptic symptoms are likely to come and go.
If you are infected with H. pylori, the first treatment usually tried is to clear the H. pylori infection. However, as mentioned, infection with H. pylori is probably a coincidence rather than a cause in most cases of non-ulcer dyspepsia. For example, one study found that only about 1 in 15 people with non-ulcer dyspepsia who were infected with H. pylori were cured by clearing H. pylori. Treatment, briefly, involves a one-week course of two antibiotics plus an acid-suppressing medicine.
A one-month trial of medication that reduces stomach acid is often advised. This helps in some cases, but not all. It may work because the lining of your stomach may be extra sensitive to the acid. Or, it may work because you may have very mild inflammation in your stomach that comes and goes, but is never found if you have an endoscopy test to look into your stomach.
There are two groups of medicines that reduce stomach acid - proton pump inhibitors (PPIs) and H2-receptor antagonists. They work in different ways but both reduce (suppress) the amount of acid that the stomach makes. PPIs include: omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. H2-receptor antagonists include: cimetidine, famotidine, nizatidine, and ranitidine. There are several brands in each group.
If medication helps, then further courses may be advised if symptoms persist. Many people take acid-suppressing medication as required. That is, waiting for symptoms to develop before taking a short course of treatment. Some people take acid-suppressing medication regularly if symptoms occur each day.
The National Institute for Health and Clinical Evidence (NICE) recommends the following lifestyle changes:
Symptoms of non-ulcer dyspepsia tend to come and go. You are likely to have times when symptoms go completely, and times where they are troublesome. Non-ulcer dyspepsia does not lead to cancer or other serious illnesses.