What are the treatment options for an upset stomach?

Treatment Options for Upset Stomach

For an upset stomach, first-line treatment includes dietary modifications, antispasmodics for pain, and specific medications targeting predominant symptoms such as loperamide for diarrhea or fiber supplements for constipation. 1

Initial Approach

Dietary Interventions

• Identify and eliminate potential trigger foods
• Small, frequent meals rather than large meals
• Reduce intake of:
  • Caffeine-containing beverages
  • Gas-producing foods
  • Poorly absorbed carbohydrates (lactose, fructose)
  • Fatty foods 1, 2

Symptom-Specific Medications

For Abdominal Pain/Cramping

• Antispasmodics (first-line treatment)
  • Anticholinergics (dicyclomine, hyoscine butylbromide)
  • Direct smooth muscle relaxants (alverine, mebeverine)
  • Start at low dose to minimize side effects 1, 2

For Diarrhea

• Loperamide 2-4 mg up to four times daily
  • Reduces loose stools, urgency, and fecal soiling
  • Can be used regularly or prophylactically
  • Caution: May cause constipation at higher doses 1, 2
• Cholestyramine (for post-cholecystectomy patients or bile acid malabsorption) 1

For Nausea and Vomiting

• Dopamine receptor antagonists:
  • Prochlorperazine
  • Metoclopramide
  • Haloperidol
  • Olanzapine 1
• For persistent nausea, consider adding:
  • 5-HT3 receptor antagonists
  • Anticholinergic agents
  • Antihistamines 1

For Constipation

• Increase dietary fiber (25g/day)
  • Soluble fiber (ispaghula) is better tolerated than insoluble fiber (wheat bran)
  • Start at low dose (3-4g/day) and gradually increase 1
• Polyethylene glycol for more severe constipation 2

Advanced Treatment Options

For Persistent Symptoms

• Tricyclic antidepressants (TCAs) for moderate to severe pain
  • Amitriptyline 10-50mg at bedtime
  • Effective at lower doses than those used for depression
  • Particularly helpful when pain is frequent or severe 1, 2
• Selective serotonin reuptake inhibitors (SSRIs)
  • Consider for patients with comorbid anxiety/depression
  • Less effective for pain than TCAs 1, 2

Specialized Diets

• Low FODMAP diet for persistent symptoms
  • Should be implemented under dietitian supervision
  • Includes reintroduction phase to identify specific triggers 1, 2

Psychological Interventions

For symptoms associated with stress or anxiety:

• Relaxation techniques
• Cognitive behavioral therapy
• Gut-directed hypnotherapy
• Biofeedback 1, 2

Common Pitfalls to Avoid

1. Overuse of antacids - May provide temporary relief but don't address underlying causes
2. Prolonged use of antispasmodics - Can cause anticholinergic side effects
3. Ignoring psychological factors - Stress and anxiety often exacerbate symptoms
4. Excessive dietary restrictions - May lead to nutritional deficiencies
5. Delayed treatment escalation - If symptoms persist after 2-4 weeks of first-line therapy, consider changing approach 1, 2

When to Seek Further Evaluation

• Presence of alarm symptoms (weight loss, bleeding, anemia)
• Age over 45-55 years with new onset symptoms
• Family history of gastrointestinal cancers
• Symptoms that persist despite appropriate treatment for 4-8 weeks 2, 3

For most patients with simple upset stomach, a stepwise approach starting with dietary modifications and targeted symptom-specific medications will provide relief. More complex or persistent cases may require additional interventions including psychological therapies or specialized diets.