What causes stomach spasms?

What Causes Stomach Spasms?

Stomach spasms are primarily caused by abnormal gut motility and visceral hypersensitivity resulting from dysfunction in the gut-brain axis, with common triggers including meals, stress, gastrointestinal infections, medications (especially NSAIDs and opioids), and underlying functional disorders like IBS or functional dyspepsia. 1

Primary Pathophysiological Mechanisms

Abnormal Gut Motility

• High amplitude propagating contractions (HAPCs) directly cause spasms and cramping, with over 90% of these contractions coinciding with abdominal pain or cramps in patients with diarrhea-predominant conditions 1, 2
• Patients experiencing spasms often have increased motility, more frequent HAPCs, and accelerated colonic transit compared to those without symptoms 1
• Abnormal fasting and postprandial (after-meal) motility patterns trigger spasms even when overall transit time appears normal 1

Nerve Sensitization (Visceral Hypersensitivity)

• Approximately 60% of patients with stomach spasms have visceral hypersensitivity, where gut nerves become abnormally sensitized and overreact to normal stimuli like food, gas, or bowel contractions 2
• Peripheral sensitization occurs when inflammatory mediators (prostaglandins, serotonin, histamine, cytokines) directly act on nerve terminals, upregulating their sensitivity and causing primary hyperalgesia 1, 2
• Central sensitization amplifies pain signals in the spinal cord, causing non-painful stimuli (like normal digestion) to be perceived as painful spasms 1, 2

Autonomic Nervous System Dysfunction

• Reduced parasympathetic (vagal) activity combined with increased sympathetic activity is consistently observed in patients with stomach spasms 1, 2
• This imbalance impacts gut motility, visceral sensitivity, inflammation, and gut permeability, all contributing to spasm generation 1, 2

Common Triggering Factors

Postinfectious Changes

• 10-20% of patients develop stomach spasms following acute gastroenteritis caused by bacteria (Salmonella, Campylobacter, E. coli), parasites (Giardia), or viruses (Norovirus) 1, 2
• Infection increases mucosal T lymphocytes and activated mast cells near nerve endings, creating an environment that perpetuates spasms even after the infection resolves 1, 2

Medications and Substances

• NSAIDs and opioids are strongly associated with stomach spasms through multiple mechanisms including altered gut motility and direct mucosal injury 1, 3
• Anticholinergic drugs and narcotics cause intestinal ileus or altered motility patterns that manifest as spasms 3
• Vasoconstrictor drugs (ergotamines, amphetamines, cocaine) can cause ischemic bowel disease presenting with severe spasms 3
• Alcohol excess alters gut motility and can trigger spasms 1

Dietary Triggers

• Meal ingestion produces an exaggerated motility response in susceptible individuals, triggering postprandial spasms 1, 4
• Common food intolerances (wheat, dairy, coffee, onions) may trigger spasms, though true food allergy is rare 1
• Lactose intolerance affects 10% of patients with spasms but lactose exclusion rarely eliminates symptoms completely 1

Stress and Psychological Factors

• Chronic stress, anxiety, and depression increase the frequency and severity of stomach spasms through gut-brain axis dysfunction 1
• Approximately 50% of patients attribute symptom onset to a stressful life event 1
• Maladaptive coping mechanisms amplify symptom perception and spasm frequency 1

Associated Functional Disorders

Irritable Bowel Syndrome (IBS)

• IBS is characterized by recurrent abdominal pain/spasms associated with altered bowel habits (diarrhea, constipation, or mixed) 1
• Changes in serotonin metabolism influence motility patterns, with high levels in diarrhea-predominant patients and low levels in constipation-predominant patients 1
• Low-grade mucosal inflammation from compromised epithelial barrier, dysbiosis, or altered stress levels perpetuates spasms 1

Functional Dyspepsia

• Upper abdominal or epigastric spasms/pain present in fasting conditions and/or precipitated by meals characterize functional dyspepsia 1
• Unlike IBS, the pain is unrelated to defecation 1
• Up to 50% of patients have overlapping IBS, experiencing two different types of abdominal pain 1

Less Common Causes Requiring Exclusion

Organic Disease

• Gastro-oesophageal cancer, inflammatory bowel disease, and coeliac disease must be excluded, particularly with alarm features (weight loss, rectal bleeding, age >40-60 years depending on risk factors) 1
• Biliary colic presents as epigastric spasms with specific characteristics warranting abdominal ultrasound 1

Neuromuscular Disease

• Familial or nonfamilial visceral myopathies, collagen diseases, muscular dystrophies, and amyloidosis can cause gastrointestinal smooth muscle dysfunction presenting as spasms 5
• Enteric nerve dysfunction from diabetes mellitus, Chagas' disease, or Parkinson's disease may manifest as spasms 5

Critical Clinical Pitfalls

• Do not assume all stomach spasms are benign functional disorders—screen for alarm features requiring urgent investigation (weight loss with dyspepsia age ≥25 years, age >40-60 years with new-onset symptoms, family history of gastro-oesophageal malignancy) 1
• Recent medication changes, particularly NSAIDs or opioids, are frequently overlooked as causative factors 1, 3
• Previous acute gastrointestinal infection should be specifically queried, as 10-20% of postinfectious cases develop chronic spasms 1
• Eating disorders and disordered eating behavior are increasingly recognized in patients with stomach spasms and should be screened 1