In one-fourth of cases, no medical reason is found for severe or persistent upset stomach.
Frequent or persistent pain, fullness, and bloating may need a doctor’s evaluation.
In the classic Alka-Seltzer TV commercial from the 1970s, pajama-clad Ralph sits on the edge of the bed moaning regretfully, “I can’t believe I ate the whole thing.” Sometimes stomach discomfort after eating is just a passing malady, and a simple antacid and a little patience is all you need. But when it happens often or lasts for weeks, get it checked out.
Medical textbooks call an upset stomach dyspepsia, and it’s more than just a touch of occasional heartburn. The main signs include
pain in the upper belly
feeling that you fill up quickly when eating meals
feeling bloated and overfull after you stop eating.
In a quarter of cases, no underlying cause is ever found. But an exam is still worth the trouble. “Especially in an older person, you want to make sure you are not missing something severe, like cancer,” says Dr. Jacqueline Wolf, a gastroenterologist and associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. “Most of the time, we don’t find anything in particular. But if you’ve experienced weight loss or other alarm signals, then you need to seek attention.”
Rule out red flags
In children, a tummy ache is usually just a tummy ache, and it goes away as quickly as it comes on. But doctors cast a more watchful gaze on digestive complaints after middle age. That’s when serious gastrointestinal issues—such as ulcers and esophageal cancer—become more common.
Possible red flags include weight loss, fatigue, blood in the stool, vomiting, loss of appetite, or pain or difficulty swallowing. If you have dyspepsia along with such alarm signs, your doctor may want to do an endoscopy, which means lowering a lighted instrument down your throat to take a look for problems.
Heartburn and dyspepsia
For most men, the most common form of gut-related distress will be poor Ralph’s garden-variety acidic heartburn, or gastroesophageal reflux disease (GERD). However, dyspepsia symptoms (fullness and bloating) can occur along with GERD. Frustratingly, treating the GERD with an acid-reducing medication won’t necessarily conquer the dyspepsia. Then what?
Dyspepsia can also be due to a chronic infection with Helicobacter pylori, a bacterium in the gut. If your doctor finds this, you may need to take antibiotics and an acid-reducing medication to eradicate the bacteria. This may or may not help with the dyspepsia, and the antibiotics could make you feel even sicker temporarily if you have a bad reaction to them.
Common over-the-counter painkillers can also cause dyspepsia: ibuprofen (Advil, Motrin), naproxen (Aleve), and ordinary aspirin. Alcohol is another common offender.
What else may help
For persistent dyspepsia, a “try it and see” approach is often the only option. “If you can’t find a cause, you can try things and see if you get a response,” Dr. Wolf says. Here are a few strategies that may help:
Eliminate triggers. Pay close attention to what foods may trigger the symptoms and then avoid eating them and see if it makes a difference. For example, skip dairy foods for a week and see if the upset stomach goes away.
Avoid fatty foods. These tend to slow down the emptying of the stomach, which may contribute to the feeling of fullness.
Break up meals. Try eating smaller but more frequent meals. For example, eat a light breakfast and then split both lunch and dinner into two smaller meals spaced an hour or two apart.