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Irritable stomach: causes, symptoms and treatment

by Josephine Andrews
Published: Last Updated on 290 views

Doctors refer to recurring or chronic symptoms in the upper abdomen as irritable stomach (functional dyspepsia). Those affected report discomfort, pain and pressure in the abdomen or a feeling of fullness in the stomach. Since there are no organic causes, doctors make the diagnosis by elimination. You can read more about the symptoms, course and treatment of irritable stomach here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.


quick overview

  • What is an irritable stomach? Irritable stomach refers to recurring or chronic complaints in the upper abdominal area without a recognizable organic cause.
  • Symptoms : Individually very different complaints such as pain in the upper abdomen, malaise, feeling of fullness, heartburn, loss of appetite, palpitations.
  • Is an irritable stomach curable? The symptoms often do not disappear completely, but they can be significantly alleviated.
  • Frequency : About 20 percent of the population is affected annually.
  • Causes : The exact cause of functional dyspepsia is unknown. Presumed factors include lack of gastric mobility, increased sensitivity of the gastric nerves.
  • Diagnosis : The doctor excludes other diseases by means of various examinations.
  • Treatment : Therapy for irritable stomachs focuses on alleviating the symptoms (eg through dietary adjustments, medication, lifestyle changes).
  • Prevent : Stress reduction, regular exercise

What is an irritable stomach?

An irritable stomach (RM) is a functional digestive disorder – also called functional dyspepsia or irritable stomach syndrome (RMS). The term describes a number of different complaints of the upper abdomen, which are not based on organic causes. This means that there are physical symptoms, but no physical cause such as inflammation can be identified. About 20 percent of the population are more or less frequently affected by symptoms of an irritable stomach every year. In many cases, the symptoms are chronic. An irritable stomach is basically not dangerous, but it can severely impair the quality of life.

What are the symptoms of an irritable stomach?

The symptoms of an irritable stomach vary greatly from person to person. Affected people often seek their doctor because of “indigestion”, a “nervous stomach”. ” or upper abdominal complaints.

The following symptoms can occur in different degrees with an irritable stomach:

  • malaise
  • Girdle-like or vague upper abdominal pain
  • feeling of pressure in the stomach
  • bloating
  • Rapid feeling of satiety
  • nausea and vomiting
  • heartburn
  • Acid regurgitation
  • Loss of appetite and sudden aversion to certain foods (eg, alcohol, coffee, high-fat foods, sugar)
  • stool irregularities ( e.g. diarrhea )
  • Bloating (flatulence), bloating (meteorism)
  • Vegetative complaints such as circulatory problems , palpitations, palpitations , increased sweating

It is typical for an irritable stomach that the pain in the upper abdomen persists or keeps recurring and has occurred at least three times a week for more than three months in the past six months. In addition, the symptoms do not improve after defecation.

Based on certain criteria (Rome IV criteria), doctors differentiate between two types of functional dyspepsia, which can also exist at the same time:

  • Epigastric Pain Syndrome (EPS) : Pain and burning in the upper abdomen occurs regardless of meals.
  • Postprandial Distress Syndrome (PDS) : Feelings of fullness, nausea and early satiety after eating.

All of these symptoms can be an irritable stomach, but a physical cause is also possible. Therefore, consult a doctor if your upper abdominal pain persists for a long time. With the help of various examinations, he excludes other diseases (differential diagnostics).

Irritable stomach or irritable bowel?

Both irritable stomach and irritable bowel are functional digestive disorders. They are among the most common diseases of the digestive system. Typical symptoms of irritable bowel syndrome are pain in the middle/lower abdomen and alternating diarrhea and constipation . Those affected also report flatulence and excrete mucus when going to the toilet.

In 40 percent of cases, people with a nervous stomach also have irritable bowel symptoms. Conversely, people with an irritable bowel also report complaints that are attributed to an irritable stomach. Both symptoms can also have symptoms that are not related to the abdomen, such as headaches , sleep disorders, and bone and joint problems.

Since similar causes are discussed for irritable stomach and irritable bowel, doctors assume that they are related and often occur together. In some cases, functional dyspepsia also occurs together with reflux symptoms. This causes gastric juice to flow back into the esophagus .

Is an irritable stomach curable?

Functional dyspepsia is uncomfortable but harmless. As a rule, there are no complications or secondary diseases. However, an irritable stomach is usually chronic. Only every fifth person affected becomes completely symptom-free again. However, the symptoms can be significantly reduced with treatment.

Is an irritable stomach dangerous?

Basically, a nervous stomach is harmless. However, the recurring symptoms sometimes have a severe impact on everyday life. See a doctor if your symptoms last longer, are particularly painful or occur frequently. It can also hide serious illnesses.

Attention: See a doctor as soon as possible if you experience the following symptoms:

  • unwanted weight loss
  • recurrent vomiting
  • Severe, persistent stomach pain
  • Swallowing disorders (dysphagia)
  • vomiting blood (hematemesis)
  • blood in the stool
  • hard belly
  • Enlarged lymph nodes

How long does an irritable stomach last?

The symptoms of an irritable stomach usually last for a long time (at least three months permanently or repeatedly for several days). In some cases, they even exist for years. However, with various treatments, the symptoms usually improve significantly.

How does irritable stomach come about?

So far, it has not been clearly clarified how an irritable stomach develops, because there is no identifiable physical cause. Doctors believe, however, that several factors play a role in its development. This includes:

  • Disturbed digestive processes : It is possible that the stomach and small intestine muscles do not work together properly in the case of an irritable stomach. As a result, the stomach empties only slowly (in 30 to 80 percent of those affected), but sometimes also unusually quickly. The cause of the pain may be hypersensitivity of the nerves in the gastrointestinal tract (visceral hypersensitivity) or an increased perception of pain.
  • Psychological stress : In addition to functional dyspepsia, some sufferers have states of anxiety, neurosis or depression. Some patients worry about a serious illness. This in turn can increase the irritable stomach symptoms.
  • Infection with Helicobacter bacteria (H. pylori) : The role played by the bacterium Helicobacter pylori in an irritable stomach has not yet been fully clarified. After an infection, H. pylori nests in the stomach lining, but does not necessarily cause symptoms there. However, it can cause stomach disorders, such as stomach and duodenal ulcers or inflammation of the stomach lining (gastritis). A direct link between Helicobacter pylori and irritable stomach has not been proven, but some patients with functional dyspepsia also have gastritis caused by H. pylori.
  • Disturbed function of the microbiome : The microbiome is the complete genetic information of the microorganisms living on and in the body. The intestinal microbiome with the intestinal bacteria not only plays an important role in digestion, but also in maintaining health. Doctors suspect that the irritable stomach could be due to a disturbed composition or function of the microbiome.
  • Medications such as calcium channel blockers, bisphosphonates, iron preparations, corticosteroids, estrogens or certain antibiotics are discussed as the cause of irritable stomach complaints.

How do you recognize an irritable stomach?

The diagnosis irritable stomach is a diagnosis of exclusion (differential diagnosis). The doctor therefore first rules out other diseases that cause similar symptoms. These include inflammation of the gastric mucosa, stomach ulcers, malignant tumors of the stomach and esophagus (stomach cancer, esophageal cancer ), diseases of the bile ducts, liver or intestines. The first point of contact for irritable stomach complaints is the family doctor. If necessary, he or she will refer the patient to a specialist in gastrointestinal diseases (gastroenterologist).


At the beginning of the diagnosis there is a detailed discussion with the patient. A precise description (type, duration and severity) of the symptoms gives the doctor initial indications of functional dyspepsia.

Clinical examination

During the subsequent physical examination, the doctor feels, among other things, the abdomen. If he finds no pathological changes in the area of ​​the gastrointestinal tract, the suspicion of functional dyspepsia is confirmed.

Further investigations

To make sure that it is not another disease with symptoms similar to those of irritable stomach, the doctor will examine the patient further as necessary. With the help of a blood test, it can be determined, among other things, whether inflammation values ​​are elevated, which suggest a physical cause such as inflammation of the gastric mucosa (gastritis). A stool examination is also useful to rule out organic causes.

For further diagnostics, doctors use an ultrasound examination (sonography) of the gastrointestinal tract. In esophagogastroduodenoscopy (EGD), they examine the esophagus, stomach and the beginning of the intestine with an endoscope. This is how they recognize stomach ulcers, for example. If necessary, doctors take tissue samples during this examination and examine them for the presence of the bacterium Helicobacter pylori. Further tests are possible to rule out food intolerance (e.g. lactose intolerance, fructose intolerance or histamine intolerance).

In around a quarter of the patients examined, organic causes, such as gastritis or reflux disease, can be identified by carefully examining the symptoms. Three quarters of those affected receive the diagnosis “irritable stomach” due to unremarkable test results.

symptom diary

In order to get a better impression of the symptoms that bother the patient the most, doctors recommend keeping a symptom diary including a diet log for a few weeks. Those affected enter the following points, among others:

  • Appearing complaints
  • Time and severity of occurrence
  • All meals and the amount of each
  • Other special features
  • General living conditions

What can you do against an irritable stomach?

A first important step in treating irritable stomach is for the doctor to explain to the patient: What is the disease? What is it triggered by? What is the therapy like? What can I do on my own?

Because as different as the symptoms of an irritable stomach are from person to person, the corresponding therapy is also individual. Since no specific cause is treated for functional dyspepsia, treatment aims to relieve the symptoms.

Diet for irritable stomach

There is no general nutritional or diet recommendation for an irritable stomach. The best way for those affected to find out for themselves what is good for them and what is not is through careful experimentation. It is not only the food itself that plays a role, but also the way it is prepared.

Some patients find it helpful to change their diet and lifestyle:

  • Avoid very spicy, sweet, spicy, very cold or hot foods.
  • Space out your meals throughout the day: Several small portions may be better than a few large ones.
  • It’s best not to get distracted while eating. Choose a quiet place and allow enough time for your meals.
  • Refrain from smoking and alcohol.
  • Make sure you eat a healthy, balanced diet and get enough exercise to avoid becoming overweight.

In addition to nutrition, permanent physical or mental stress favors the typical irritable stomach symptoms. Therefore, try to make lifestyle changes to reduce stress. For example, try relaxation exercises such as autogenic training, yoga or progressive muscle relaxation, and plan conscious recovery phases in everyday life. Regular exercise also helps to reduce stress. Psychotherapy is advisable if there are accompanying psychological symptoms such as anxiety or depression.

Home remedies for irritable stomach

Some sufferers use home remedies for their irritable stomach complaints. Even if their effect has not been scientifically proven, they are often beneficial and relieve some symptoms. Try out which home remedies will help you:

  • Heat is often beneficial for stomach pain and cramps. A hot-water bottle or a warm cherry pit pillow stimulate blood circulation and relax tense muscles.
  • A gentle abdominal massage (eg with chamomile oil) also contributes to relaxation and relieves the irritable stomach.
  • A warm tea is beneficial for pain in the upper abdomen and digestion. Medicinal plants such as chamomile , fennel , peppermint, lemon balm and caraway can relieve stomach problems.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.


The following medications are currently used for an irritable stomach:

Prokinetics (Metoclopramide, Domperidone)

They support the movement (motility) of the stomach and thereby accelerate its emptying. However, due to possible side effects, it is recommended not to use them for longer than six to eight weeks.

Acid suppressive therapies (proton pump inhibitors, H2 blockers)

These drugs relieve symptoms in many sufferers by reducing the production of stomach acid.

Tricyclic antidepressants

If the aforementioned active ingredients do not bring satisfactory success, tricyclic antidepressants can help to improve the quality of life despite an irritable stomach.


A positive effect of herbal therapeutics (such as peppermint and caraway) has been found in the latest studies in irritable stomach symptoms.

Helicobacter pylori eradication therapy

The bacterium H. pylori can be eliminated with antibiotics (eradication therapy). Whether this treatment also improves the symptoms of functional dyspepsia is still the subject of scientific studies. According to the current state of knowledge, every tenth person affected is symptom-free afterwards.

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