From the Guidelines
For managing stomach pain, I recommend starting with a thorough assessment of the pain characteristics, including location, duration, and associated symptoms, and offering a stool test or breath test to look for a stomach infection called H. pylori, as suggested by the British Society of Gastroenterology guidelines 1.
Initial Assessment and Treatment
The initial treatment should include lifestyle modifications such as regular exercise, avoiding certain foods that may trigger symptoms, and managing stress differently.
- Patients should be advised to avoid spicy foods, alcohol, caffeine, and NSAIDs.
- Eating smaller, more frequent meals can also help alleviate symptoms.
- Elevating the head of the bed for nighttime symptoms can reduce reflux and discomfort.
Medication Management
If symptoms persist, consider medications that have good evidence of efficacy, such as those that reduce stomach acid or help the stomach empty more quickly, as recommended by the British Society of Gastroenterology guidelines 1.
- Patients who test positive for H. pylori should receive a short course of antibiotic treatment.
- For patients who test negative or whose symptoms continue after antibiotics, other medications such as neuromodulators can be considered to reduce abnormal sensitivity of the nerves in the upper gut.
Multidisciplinary Approach
For very severe symptoms that do not respond to any of the treatments discussed above, a multidisciplinary team of specialists, including GPs, dietitians, gastroenterologists, and psychologists, should be involved in the management of the patient, as suggested by the British Society of Gastroenterology guidelines 1.
- This team can provide high-quality, expert advice based on up-to-date research and reduce harm from unnecessary investigations and procedures, or harmful drugs.
- Nonpharmacologic therapies, such as psychological or behavioral therapies, can also be beneficial for treating symptoms in functional dyspepsia, as suggested by the AGA clinical practice update 1.
From the FDA Drug Label
In these studies, patients treated with ranitidine reported a reduction in both daytime and nocturnal pain, and they also consumed less antacid than the placebo-treated patients. Concomitant antacids should be given as needed for pain relief to patients with active duodenal ulcer; active, benign gastric ulcer; hypersecretory states; GERD; and erosive esophagitis. The management of stomach pain in a patient can be achieved with ranitidine.
- Ranitidine has been shown to reduce both daytime and nocturnal pain in patients.
- Antacids can be given concomitantly as needed for pain relief. 2 2
From the Research
Management of Stomach Pain
- Stomach pain can be a symptom of various underlying causes, including those that require surgical treatment 3.
- The management of stomach pain involves identifying whether the underlying cause requires urgent or immediate surgical intervention, or if it can be treated conservatively 3.
- Diagnostic means should be employed cost-effectively to avoid unnecessary exposure of the patient to X-rays 3.
Treatment Options
- Histamine receptor antagonists and proton pump inhibitors are used in the treatment of gastro-oesophageal reflux disease, with proton pump inhibitors being more effective in healing and symptom relief 4, 5.
- The combination of proton pump inhibitors and histamine receptor antagonists may be beneficial for patients with inadequate nocturnal acid control 4.
- Proton pump inhibitors can induce tolerance to histamine-2 receptor antagonists in Helicobacter pylori-negative patients 6.
Potential Interactions and Complications
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastrointestinal injury, and the use of proton pump inhibitors can exacerbate NSAID-induced small intestinal injury by altering intestinal microbiota 7.
- The frequent use of proton pump inhibitors is considered an independent risk factor associated with NSAID-associated enteropathy 7.