DEAR MAYO CLINIC: I have dealt with digestive issues for much of my 30s. Ulcers run in my family. My doctor said that while I could have an ulcer, testing could determine if it is functional dyspepsia. What is the difference, what causes functional dyspepsia and is it treatable?

ANSWER: Functional dyspepsia, also called nonulcer dyspepsia, and peptic ulcers can feel much the same. But, unlike a peptic ulcer, which involves open sores in the digestive tract, functional dyspepsia involves recurring indigestion or stomach pain that has no obvious cause. Common signs and symptoms of functional dyspepsia include a burning sensation or discomfort in your upper abdomen or lower chest; bloating; belching; an early feeling of fullness when eating; and nausea. While not life-threatening, the symptoms can significantly affect your quality of life.

To begin the diagnostic process, your health care professional likely will perform a physical exam. Blood tests may be performed to help rule out other diseases that can cause symptoms similar to dyspepsia.

One component to help with diagnosis is endoscopy, in which a thin, flexible, lighted instrument called an endoscope is passed down your throat so that your health care professional can view your esophagus, stomach and the first part of your small intestine. Endoscopy also allows your health care professional to collect small pieces of tissue from your stomach or duodenum to look for inflammation or cancerous growths. This procedure is called a biopsy.

Your health care professional can determine whether an endoscopy is needed, but endoscopy generally is recommended in adults 60 and older who have symptoms. A normal result on this test most often indicates functional dyspepsia. Endoscopy also may be performed on adults younger than 60 who have “alarm” features — such as weight loss, anemia, difficulty swallowing or persistent vomiting — along with dyspepsia symptoms. This is determined on an individual basis.

If no abnormal results are found with endoscopy, a noninvasive breath or stool test to check for the Helicobacter pylori, or H. pylori, bacterial infection may follow to guide the course of treatment. This test also is used for adults under 60 with no alarm features. If H. pylori is present, your health care professional may recommend an antibiotic to eliminate the infection.

For those who test negative for the bacterium, as well as for those whose symptoms persist after antibiotic treatment and clearance of H. pylori, the first line of treatment is to reduce stomach acid. This may be performed using two types of medications: proton pump inhibitors or H2-receptor blockers. Proton pump inhibitors reduce acid by shutting down the tiny pumps within stomach cells. Examples include esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec). H2-receptor blockers, including famotidine (Pepcid) and ranitidine (Zantac), reduce acid production by blocking histamine receptors in stomach cells.

If these options don’t manage your symptoms, other medications are available, including those that affect nerve endings in the stomach. Cognitive behavioral therapy also may be recommended to cope with the symptoms and reduce the stress that may trigger stomach pain. Because functional dyspepsia lacks a fully understood cause and its symptoms overlap with other gastrointestinal conditions, the diagnosis of functional dyspepsia can be challenging. Researchers continue to explore better means of clearly identifying it. — Dr. Robert Kraichely, Gastroenterology, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: I have been diagnosed with a mild case of irritable bowel syndrome, and I talked to my doctor about managing my symptoms without medication. I am interested in trying to focus more on diet to control my condition. Are there certain things that I should be mindful of, or will medication be the only way for me to manage my symptoms?

ANSWER: Although medications can be used to treat irritable bowel syndrome, not everyone who has this disorder will require or need medication. For some people — particularly those with mild symptoms — lifestyle adjustments, such as diet modification, stress management and regular exercise, are enough to control symptoms. For moderate to severe symptoms, a combination of lifestyle changes and medication may be necessary to manage irritable bowel syndrome.

Irritable bowel syndrome affects the large and sometimes small intestines. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food through the digestive tract. When you have irritable bowel syndrome, those contractions may be stronger or more noticeable than normal. That can lead to abdominal cramping and pain as food, gas or stool passes through the intestines. Irritable bowel syndrome also is associated with bowel irregularity, such as diarrhea or constipation. Other symptoms can include gas and bloating.

In those diagnosed with irritable bowel syndrome, it’s important to be aware that some abdominal issues are not associated with this disorder and could signal another underlying problem. In particular, these symptoms require prompt medical attention: blood in the stool, unexplained or rapid weight loss, unrelenting or severe abdominal pain, unexplained vomiting, significant pain with or difficulty swallowing, or an abdominal mass or lump.

Irritable bowel syndrome is a chronic condition, and symptoms tend to come and go over time. There’s no cure, but symptoms often can be eased with diet, lifestyle and stress management.

More than 60% of people who have irritable bowel syndrome say their symptoms are connected to food in some way. However, because symptoms vary significantly from one person to another, it’s difficult to give specific dietary advice that works for everyone with this disorder.

In general, though, eating high-fiber foods and drinking plenty of fluids are beneficial for many people with irritable bowel syndrome. Avoid foods and beverages that contribute to gas and bloating, including carbonated and alcoholic beverages; caffeine; raw fruit; and vegetables such as cabbage, broccoli and cauliflower. Reducing or eliminating gluten may ease diarrhea that’s related to irritable bowel syndrome.

Research has shown that certain carbohydrates, known as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP), can lead to abdominal pain, bloating and gas in people with irritable bowel syndrome. These are found in certain fruits and vegetables; wheat; rye; legumes; foods that contain lactose, such as milk, cheese and yogurt; and artificial sweeteners.

Following a diet low in FODMAPs can ease symptoms of irritable bowel syndrome. But because so many foods contain these compounds, it can be difficult for patients to create such a diet on their own. Finding a dietitian familiar with irritable bowel syndrome can help. A dietitian can review a patient’s symptoms and dietary needs, discuss recommended dietary changes, and develop an individualized food plan to ease symptoms.

Stress also affects irritable bowel syndrome, with episodes of higher stress associated with an increase in symptoms. Using stress reduction techniques and participating in activities that relieve stress, such as yoga and meditation, may decrease stress-related flare-ups. Working with a therapist or counselor experienced in stress management, mindfulness and behavior modification also may help those with irritable bowel syndrome better control stress and ease symptoms.

Regular exercise is recommended for people who have irritable bowel syndrome. Daily physical activity relieves stress, stimulates normal contractions of the intestines and promotes overall wellness.

If lifestyle changes alone aren’t enough to keep irritable bowel syndrome from disrupting daily life, talk to your health care professional about medication options. A wide variety of prescription and nonprescription medications are available to treat irritable bowel syndrome. — Dr. Robert Kraichely, Gastroenterology, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q and A: Irritable bowel syndrome and lifestyle modifications appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: Can irritable bowel syndrome be managed without medication, or is it typical that someone with this condition will need medication to control symptoms?

ANSWER: Medications can be used to treat irritable bowel syndrome, but not everyone who has this disorder needs medication. For some people, particularly those with mild symptoms, lifestyle adjustments, such as diet modification, stress management and regular exercise, are enough to control symptoms. For moderate to severe symptoms, a combination of lifestyle changes and medication may be necessary to manage irritable bowel syndrome.

Irritable bowel syndrome affects the large and sometimes small intestines. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food through the digestive tract. When you have irritable bowel syndrome, those contractions may be stronger or more noticeable than normal. That can lead to abdominal cramping and pain as food, gas or stool passes through the intestines. Irritable bowel syndrome also is associated with bowel irregularity, such as diarrhea or constipation. Other symptoms can include gas and bloating.

In those diagnosed with irritable bowel syndrome, it’s important to be aware that some abdominal issues are not associated with this disorder and could signal another underlying problem. In particular, these symptoms require prompt medical attention: blood in the stool, unexplained or rapid weight loss, unrelenting or severe abdominal pain, unexplained vomiting, significant pain with or difficulty swallowing, or an abdominal mass or lump.

Irritable bowel syndrome is a chronic condition, and symptoms tend to come and go over time. There’s no cure, but symptoms often can be eased with diet, lifestyle and stress management.

More than 60% of people who have irritable bowel syndrome say their symptoms are connected to food in some way. However, because symptoms vary significantly from one person to another, it’s difficult to give specific dietary advice that works for everyone with this disorder.

In general, though, eating high-fiber foods and drinking plenty of fluids are beneficial for many people with irritable bowel syndrome. Avoid foods and beverages that contribute to gas and bloating, including carbonated and alcoholic beverages; caffeine; raw fruit; and vegetables such as cabbage, broccoli and cauliflower. Reducing or eliminating gluten may ease diarrhea that’s related to irritable bowel syndrome.

Research has shown that certain carbohydrates known as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) can lead to abdominal pain, bloating and gas in people with irritable bowel syndrome. These are found in certain fruits and vegetables; wheat; rye; legumes; foods that contain lactose, such as milk, cheese and yogurt; and artificial sweeteners.

Following a diet low in FODMAPs can ease symptoms of irritable bowel syndrome. But because so many foods contain these compounds, it can be difficult for patients to create such a diet on their own. Finding a dietitian familiar with irritable bowel syndrome can help. A dietitian can review a patient’s symptoms and dietary needs, discuss recommended dietary changes, and develop an individualized food plan to ease symptoms.

Stress also affects irritable bowel syndrome, with episodes of higher stress associated with an increase in symptoms. Using stress reduction techniques and participating in activities that relieve stress, such as yoga and meditation, may decrease stress-related flare-ups. Working with a therapist or counselor experienced in stress management, mindfulness and behavior modification also may help those with irritable bowel syndrome better control stress and ease symptoms.

Regular exercise is recommended for people who have irritable bowel syndrome. Daily physical activity relieves stress, stimulates normal contractions of the intestines and promotes overall wellness.

If lifestyle changes alone aren’t enough to keep irritable bowel syndrome from disrupting daily life, talk to your health care provider about medication options. A wide variety of prescription and nonprescription medications are available to treat irritable bowel syndrome. — Dr. Robert Kraichely, Gastroenterology, Mayo Clinic, Rochester, Minnesota

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Related Articles

• Mayo Clinic Radio: Irritable bowel syndrome published 4/4/19
• Pregabalin may lessen pain from irritable bowel syndrome, Mayo Clinic study finds published 10/17/16
• Home Remedies: Irritable bowel syndrome published 10/14/16

The post Mayo Clinic Q & A: Managing irritable bowel syndrome appeared first on Mayo Clinic News Network.

In this Mayo Clinic Radio program, Dr. Robert Kraichely, a Mayo Clinic gastroenterologist, will discuss treatment for IBS. Also on the program, Dr. Jennifer Vande Voort, a Mayo Clinic psychiatrist, will discuss esketamine nasal spray — a fast-acting treatment for depression that recently was approved by the Food and Drug Administration. And Dr. Nipunie Rajapakse, a Mayo Clinic infectious diseases specialist, will share what you need to know about childhood vaccines.

Here's your Mayo Clinic Radio podcast.

The post Irritable bowel syndrome / esketamine for depression / kids and vaccines: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Robert Kraichely, a Mayo Clinic gastroenterologist, will discuss treatment for IBS. Also on the program, Dr. Jennifer Vande Voort, a Mayo Clinic psychiatrist, will discuss esketamine nasal spray — a fast-acting treatment for depression that recently was approved by the Food and Drug Administration. And Dr. Nipunie Rajapakse, a Mayo Clinic infectious diseases specialist, will share what you need to know about childhood vaccines.

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Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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