Belching, bloating, gastric distention, stomach pain or cramps, heartburn and nausea, even vomiting - these are typical symptoms of irritable stomach syndrome. Although there are broad overlaps with irritablebowel syndrome, the symptoms are not the same.
What is an irritable stomach?
Strictly speaking, the term "irritable stomach" or "irritable bowel" is outdated. Today, the plethora of complaints in the area of the gastrointestinal tract without physical findings are summarized as "functional gastrointestinal complaints" (gastrointestinal = affecting the gastrointestinal tract).
What exactly is meant by this was defined by the experts present at a conference in Rome in 1992 and subsequently referred to as the "Rome criteria". In 1999 and 2006, these were revised and are now recognized worldwide as the Rome II and Rome III criteria, respectively.
There is a spectrum of six main symptoms:
- Symptoms from the esophagus side
- Symptoms from the side of the stomach/duodenum
- Symptoms from the side of the large intestine (irritable bowel syndrome)
- Abdominal pain
- Gallbladder symptoms
- rectal symptoms.
In each of these categories there are again subdivisions.
Upper abdominal discomfort
The group of gastrointestinal/duodenal disorders includes the following:
- Functional dyspepsia ("indigestion").
- Postprandial distress syndrome (discomfort after eating)
- Upper abdominal pain syndrome
- Functional air regurgitation
- Air swallowing
- Nonspecific excessive air regurgitation
- Nausea and vomiting
- Chronic idiopathic nausea (idiopathic = without known cause)
- Functional vomiting
- Cyclic vomiting syndrome
Each of these complaints is precisely defined. The starting point is the frequency. The symptoms should be present in half the time. This means three months in the last six months. Then follows a list of symptoms.
For example, one speaks of "dyspepsia" when the following conditions are present:
At least one of the following symptoms occurs for at least three months during the past six months:
- Unpleasant feeling of fullness after eating
- Accelerated feeling of fullness
- Pain in the upper abdomen
- Burning in the upper abdomen
Even though dozens of different diseases can be defined in this way, they overlap and, above all, the many different clinical pictures can be reduced to a few causes.
The symptomatology is extremely common. Between 20-40% of the population is said to suffer from it. At the general practitioner about every 10th patient complains about digestive problems and at the gastroenterologist it is every third. However, gastroscopy reveals just as few findings as laboratory tests or ultrasound.
About half of those affected consult a doctor. Many have resigned themselves to it or have resigned themselves because the prescribed medications have not helped.
In terms of life expectancy, irritable stomach is a harmless disease. One can grow old with it. The view is far less favorable when one looks at the quality of life. A larger proportion of those affected feel impaired and threatened by the symptoms.
They try again and again with new medications. Initially, the family doctor is consulted, then specialists and clinics. If there is no success, Mother Nature is supposed to fix what the pharmaceutical industry cannot. But here, too, the failures are frequent. It often gets better at first, but then the familiar symptoms return.
In diagnostics, it is important to diagnose sufficiently accurately but not excessively. Patients who have already had three gastroscopies with normal findings should not necessarily be mirrored again unless the complaints have changed fundamentally.
Appropriate diagnostics include, above all, a detailed discussion with an appropriately experienced physician. In most cases, most things can be clarified here.
Laboratory tests are the next step. A number of values are included: Blood count, blood sedimentation or CRP, transaminases, creatinine and lipase. Helicobacter pylori can also be examined in the blood or stool.
Ultrasound examination of the upper abdomen is also useful and has no relevant side effects.
Gastroscopy provides the best information about the condition of the stomach. Side effects are very rare. Above all, gastroscopy should be performed in case of:
- Complaints for the first time over the age of 45
- Unwanted weight loss
- Gastrointestinal bleeding
- Anemia due to iron deficiency
- Persistent vomiting
- Palpable changes in the upper abdomen
- Stomach cancer/esophageal cancer in the family
About one in three irritable stomach patients develops the symptoms after an acute gastrointestinal infection. The acute symptoms after a summer flu or after food poisoning in an exotic vacation destination may pass, but the increased sensitivity remains. Whereas in the past there were hardly any problems with digestion, the stomach now reacts mimosa-like to any stress.
In the mucous membrane, these patients actually show signs of a slight inflammation. Possibly, a vicious circle occurs here as well. The inflammation lowers the stimulus threshold, which can lead to a so-called neurogenic (= caused by the nerves) inflammation.
In about every third adult in Germany, a bacterium called Helicobacter pylori is found in the stomach. In most cases, this germ does not cause any symptoms. But sometimes its activity leads to a stomach ulcer.
By combining 2 or 3 different antibiotics with a drug that inhibits stomach acid, ulcers can be successfully treated.
Antibiotic therapy of peptic ulcer has been one of the great advances in internal medicine in recent decades.
Encouraged by the successes with peptic ulcer, attempts were repeatedly made to treat irritable stomach with antibiotics as well. But the successes failed to materialize. A connection with the culprit Helicobacter could not be proven.
It has been well studied that in irritable stomach and irritable bowel disorders, the movements of the gastrointestinal tract are altered. Food remains in the stomach for too long in about 40% of those affected. The consequences are a feeling of fullness and loss of appetite.
In the intestine, on the other hand, the food mush often moves too quickly before the food components have been absorbed into the blood. There is now an oversupply of food calories in the lower small intestine and colon. Bacterial growth and gas production increase. Flatulence is the result. At the same time, the affected person may notice increased bowel movements and noises in the abdomen.
I see the increased intestinal movement as a result of the increased sensitivity. This easily results in a vicious circle. The increased intestinal movements and intestinal gases lead to an increase in sensitivity, i.e. a lowering of the stimulus threshold. This increases motor activity, etc.
For a long time, stomach acid was considered the sole culprit. But in fact, increased production of gastric acid is rarely found. The stomach reacts more quickly "acidified" when it comes into contact with its own hydrochloric acid.
If one reads medical articles, the chapter on causes usually begins with the statement that the origin of the complaints is "unclear", "complex" or "not yet understood".
One of the most important results came from stretching tests of the gastrointestinal tract. For this purpose, a gastroscopy was performed and a small balloon was inflated, which was located at the tip of the endoscope. In this way, it was possible to selectively dilate the esophagus, stomach or duodenum. The interesting question was, how do patients with irritable stomach complaints react to this stretching stimulus?
If you have already studied fibromyalgia and related functional disorders a little, you will hardly be surprised by the result. Patients with irritable stomach and irritable bowel complaints were far more sensitive than control patients. In short, they showed increased sensitivity of the gastrointestinal tract.
There is much evidence to suggest that a whole cascade of increased sensitivity explains the complaints and thus bears strong similarities to chronic pain. It begins with the nerves of the stomach and intestines, continues in the spinal cord, and ends in excessive brain activation, as can be determined with modern examination techniques (fMRI). In addition, a lack of attenuation of the flood of stimuli in the spinal cord is discussed, much as is known in pain disorders.
This increased sensitivity does not only refer to stretch stimuli. The alimentary canal also seems to overreact to its own movements, acid stimuli, bile or food.
Twin studies show that genetic factors play a role in functional gastrointestinal disorders. It is not a single gene that is altered. It is the combination of different hereditary traits that results in a higher susceptibility to symptomatology. Interestingly, those genes that interfere with serotonin metabolism seem to be of particular importance. This may explain why an irritable stomach/intestine is frequently associated with anxiety disorders or depression. Diseases in which serotonin alterations have been described.
The more unfavorable a person's early development, the more susceptible he or she is to irritable stomach symptomatology. This can be severe strokes of fate, physical/mental assault, lack of security, insecurity or other forms of impairment. Overanxious parents who worry too much about a child's smallest complaints can also increase awareness of the child's sensitivities.
Likewise, a parent's health behaviors influence a new earthling. Do they tend to go to the doctor frequently or infrequently? Are physical impairments the focus of conversation? Do stomach complaints have increased importance because a family member died of stomach cancer that went undetected for a long time? etc.
Few things affect well-being as much as sleep. A few nights full of restless, worrying, superficial sleep, repeatedly interrupted by periods of wakefulness, makes people irritable and depressed, affects the quality of life and performance.
Research shows that sleep also affects the stomach and intestines. The more restful the sleep, the calmer and more relaxed the digestive tract behaves. However, if you feel exhausted in the morning, your stomach will also react in a disgruntled manner.
Tension and anxiety
Essential to the discomfort is the meaning associated with the symptoms. After an excessively heavy meal, most people suffer from an increased burden with the body. But this is explainable and at most triggers worries about the consequences for the slim line.
But it is different when inexplicable discomfort occurs after a normal meal. If the attention is then directed full of concerns to the belly, this leads to an involuntary sinking of the stimulus threshold. If now the fear of a bad illness, e.g. stomach cancer, is added, a circle of increased attention, fear, sinking of the stimulus threshold and increased symptoms results easily.
It is also unfavorable when doctors make dangerous-sounding tentative diagnoses or when ever new examinations only lead to further uncertainty.
The background of the complaints - it was shown above - is mainly the increased sensitivity of the digestive tract. Although it is difficult to visualize the sensitivity at present, its effects are very real. Food is transported too slowly or too quickly, bacteria multiply excessively, gases cause over-inflation of the intestines, constipation or diarrhea are the result.
The causative therapy is to raise the irritability threshold. This is usually not achievable by medication alone. Multimodal therapies are useful, in which attempts are made in a variety of ways to limit the excessive sensitivity. How this is done in general is described in detail in the therapy section.
Nevertheless, here are some specific notes on the therapy of irritable stomach.
Medication: Proton pump inhibitors
As mentioned, it makes no sense at all to take antibiotics against Helicobacter, since this germ causes gastric ulcers but not irritable stomach.
In irritable stomach, there is also no increased acid production. Reducing acid production therefore does not seem to make sense, since there is only an increased sensitivity to the acid.
Nevertheless, a so-called proton pump inhibitor, a drug that inhibits acid production, can provide relief, at least temporarily. When there is less hydrochloric acid in the stomach, the sensitive nerves react less irritably. Omeprazole is the most commonly prescribed drug. There are studies showing superiority of omeprazole over placebos. This is especially true when heartburn is present. However, the efficacy should not be overestimated either. The effect is not very pronounced. The fact that abdominal pain, nausea, flatulence and diarrhea, of all things, are among the most common side effects must, however, be mentioned in a restrictive manner.
The acid killers are therefore not suitable as a permanent medication and are rather something for bad days.
Another class of substances attempts to influence movement in the gastrointestinal tract. They are called prokinetics (kinetics = movement). Although there are smaller studies with positive effects, their quality is less good and long-term results are lacking.
Metoclopramide also affects the motor function of the stomach. However, not only the digestive tract is affected, but also the movement of other muscles. Up to 10% of those treated get movement disorders, fatigue, restlessness, sleep disturbances, or headaches. Long-term use is unfavorable, since permanent movement disorders (so-called tardive dyskinesia) cannot be ruled out after prolonged use.
According to some studies, antidepressants lead to an improvement in symptoms. Since side effects such as dry mouth and constipation are very common, especially at higher doses, avery low dose is recommended.
Herbal home remedies usually have fewer harmful side effects. The best known are chamomile and peppermint, for whose effectiveness there are also scientific studies. Ginger is equally effective. Ginger root boiled for about 10 minutes is not only tasty, but also drives away nausea.
Other home remedies include cumin or bitter substances such as wormwood tea. (Mnemonic: "What is bitter to the mouth is healthy to the stomach").
A hot water bottle on the stomach is often an excellent immediate remedy. Alternatively, you can try a warm poultice. For this you need at least two, better three towels. A small one is doused with boiling water. It should only be well moist, not wet. Once the temperature is comfortable, the hot towel is placed on the abdomen and the body is wrapped with a dry towel. The third towel protects the mattress. So some time relaxing in bed can be a boon.
Again, no effect without side effects. Too hot hot water bottle or wraps can cause unsightly, reticulated brown discoloration on the skin of the abdomen.
Anyone suffering from an irritable stomach will find that coffee, alcohol, spicy foods, fried foods or sweets are not conducive to well-being. Surprisingly, however, "healthy" food is equally unpalatable. Coarse vegetables, fresh salads and whole grains are heavy on the stomach and can cause painful bloating.
While the unhealthy attracts acid, the healthy food leads to stronger stretching stimuli. The stomach does not appreciate either in the acute stage. Therefore, especially in the case of severe discomfort, little irritating and cooked food is best tolerated. The well-tried gruel is the first to be mentioned. It is therefore highly recommended to follow a consistent light diet for a few days, which is then gradually extended.
In the case of pronounced complaints, the diet should be gradually built up from a sparing diet to a healthy and then also tolerable diet. We also have a detailed nutrition program in book form.
However, you can already find much of it here on these pages:On the nutritional structure.
Most of those affected not only have irritable stomach symptoms, but usually also increased sensitivity in other areas: Sensitivity to noise, sensitivity to light, increased pain and increased awareness of internal organs (irritable bowel, irritable bladder, abdominal pain, etc.) increased sensitivity to cold or heat (freezing, shivering, sweating).
This is an expression of central sensitization, i.e. (almost) the entire sensory system can become hypersensitive.
The main problem of therapy is the fact that the irritable stomach complaints can usually only be treated inadequately on their own. As with other forms of increased sensitivity, multimodal treatments are necessary. In doing so, one takes advantage of the fact that the various sensory qualities are usually not independent of each other. I.e. if the sensitivity to pain, light, etc., and anxiety decreases, the hypersensitivity to smell also improves.
Father Kneipp already made use of this fact. He treated different diseases with heat and cold applications. With this "hardening", he was able to raise not only the threshold of the cold and heat sensors, but also the general threshold of irritation.
Of course, therapy must be planned individually. An overview of multimodal therapy can be found, for example, on the topic of "irritable bowel syndrome" or "fibromyalgia".