Non-ulcer Dyspepsia - Causes, Symptoms, Diagnosis and Treatment

What Is Non-ulcer Dyspepsia?

Non-ulcer dyspepsia is a medical condition in which the symptoms resemble an upper gastrointestinal disorder like an ulcer or acid reflux. But the underlying condition that causes these symptoms is not an ulcer, nor are the exact reasons known.

However, there are a few subtypes. They exhibit symptoms similar to that of GERD (gastroesophageal reflux disease), stomach ulcers (wounds or ulcers in the stomach lining), duodenal ulcers (wounds or ulcers in the duodenum) (duodenum is the first segment of the small intestine), gastritis (inflammation in the gastrointestinal tract), esophagitis (inflammation in the esophagus's lining), and delayed gastric emptying (delayed bowel movements). They vary according to the individual. In addition, they are more prevalent in young adults and females.

What Causes Non-ulcer Dyspepsia?

• Non-ulcer dyspepsia is also termed functional dyspepsia. Since the factors predisposing to this condition are unknown and no physiologic or pathological conditions cause this disease, it gets the name functional dyspepsia. Helicobacter pylori (H. pylori) infection also causes non-ulcer dyspepsia.

• In addition, non-ulcer dyspepsia also results from side effects of certain medications like Ibuprofen, Aspirin, calcium and iron supplement, antibiotics, Steroids, and so on. However, they are common and long-lasting.

• Also, most people with non-ulcer dyspepsia have reported that their symptoms and indigestion seem to occur after consuming foods like onions, pepper, fat-rich foods, citrus fruits, spicy foods, fried foods, and while consuming alcohol.

• A few studies suggest certain conditions like hypersecretion of gastric acid, changes in the gastrointestinal hormone secretions, hypersensitivity of the gastrointestinal tract or small intestine, gastric emptying, and intragastric meal distribution also contribute to predisposing the condition.

What Are the Symptoms?

• Upper abdominal region discomfort.

• Pain felt in the epigastric region.

• Bloating.

• Belching.

• Nausea.

• Indigestion.

• Dyspeptic symptoms appear after consuming foods like pepper, citrus fruits, onions, spicy foods, fried and fat-rich foods, and alcohol.

How Are They Diagnosed?

There are no specific diagnostic tests for this condition, and they are often ruled out while diagnosing other disorders like duodenal ulcers, stomach cancer, gallstones, etc. However, a few imaging studies are done to determine other physiologic problems for a clear picture.

• Endoscopy: Endoscopy is a procedure where thin tubes comprising a camera and light are inserted into the mouth to photograph the interior organs. The tube has another end attached to a monitor outside that displays the live images for the doctors for diagnosis purposes.

• Breath Test: Breath tests are done to rule out the presence of H. pylori (Helicobacter pylori) in the breath. The patient is asked to breathe in a balloon and tested for the presence of the microorganism.

• Ultrasound Abdomen: Ultrasound is an imaging method that uses high-frequency sound waves to get a snapshot of the internal organs in a photographic format to detect abnormalities.

When all these tests are done, and no defects or abnormalities are found, the condition is conclusive of functional or non-ulcer dyspepsia.

How Are They Treated?

Medications: Medications like prokinetic agents (Metoclopramide), antacids (Pantoprazole), acid-suppressing drugs (Histamine-h2 antagonist receptor), and drugs that induce bowel movements (Bisacodyl) or medicines that enhance gastric emptying are recommended.

• Antacids: However, antacids are not very beneficial in patients with this condition; in contrast, Bismuth salts (anti-diarrheal supplements) are proven effective. Despite their beneficial action, they have side effects that lead to neurotoxicity and should be considered the second treatment line.

• Histamine-h2 Antagonist Receptors: Histamine-h2 antagonist receptors are effective in most patients with non-ulcer dyspepsia.

• Prokinetic Agents: Prokinetic agents such as Cisapride, Metoclopramide, and Domperidone are the most effective among other treatment modalities, and patients who exhibit symptomatic conditions benefit from this medication.

Clearing Helicobacter Pylori Infection: Antibiotics are recommended if the cause is suspected as H. pylori (Helicobacter pylori) infection. Eradication of Helicobacter pylori is done by dual therapy or a combination of medications like antisecretory therapy and antibiotics. They have been observed to be effective; however, a few patients develop a recurrence of non-ulcer dyspepsia after a few months.

These treatment methods have been effective with improvements in the symptoms. However, a few patients may have these symptoms lingering for months or years, even with treatment.

Psychotropic Agents: Tricyclic antidepressants are also used to treat patients with non-ulcer dyspepsia. Selective serotonin reuptake inhibitors (SSRIs) and anxiolytics help improve the symptoms. However, since a few side effects have been reported and in addition to new and improved antidepressants, Tricyclic antidepressants are rarely used these days.

Miscellaneous: Altering the pain receptors by using medications like Tricyclic antidepressants, 5-HT3-receptor agonists (Ondansetron and Granisetron), and Somatostatin analogs (Octreotide) have helped improve the symptoms. Also, these medications enhance pain perception and relieve symptoms.

In addition, traditional Chinese medicine and peppermint oil have effectively treated the symptoms. However, no research has proven their efficacy, so patients should use them cautiously.

Psychological Counseling: Psychological counseling is incorporated and assures the patient that no underlying disease causes this condition. This technique is the first method incorporated into the treatment plan and gives positive and beneficial results.

In addition, psychological factors that contribute to the disease are also managed with medications. Also, certain conditions like stress, anxiety, and emotional events need to be taken care of, and if necessary, medications can be recommended.

Food Restriction: Avoiding foods like -

• Peppermint.

• Onion.

• Pickles.

• Red pepper.

• Grains.

• Salty foods.

• Pizza.

• Citrus fruits and watermelon.

• Pasta or macaroni.

• Carbonated drinks.

• Beef and red meat.

• Milk and cheese.

• Vinegar.

• Tomatoes.

• Coffee.

• Alcohol.

• Hot drinks.

• Spicy and fat-rich foods.

Lifestyle Modifications:

• Regular exercise.

• Consuming a healthy and balanced diet that comprises proteins, carbohydrates, fibers, and vitamins in equal proportion.

• Consuming food on time, as delaying meal time can cause gastric irritation and may aggravate the condition.

• Weight loss is advised in obese patients.

• Avoid smoking.

• Reduce the quantity and frequency of alcohol consumption.

Foods That Alleviate the Symptoms:

• Yogurt.

• Rice.

• Apple.

• Rock candy.

• Bread.

• Honey.

• Dates.

• Quince.

• Walnuts.

• Caraway seeds.

Conclusion:

Managing non-ulcer dyspepsia has been challenging as the causative agent remains unclear. But the treatment is based on determining if there are physical or external causative factors. Since no physiologic or pathologic conditions are figured out, they are treated with certain medications that alter or enhance pain perception, suppress stomach acid activity, improve bowel motility, and so on. And psychological counseling is done by assuring the patient that there is no underlying condition that causes these symptoms; also, certain lifestyle modifications are recommended to improve the patient's lifespan.