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Upper abdominal pain and excessive flatulence. No heartburn or blood in stool. Do I need endoscopy?

Jan 2013
User rating for this question
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Answered by

Internal Medicine Specialist
Practicing since : 2003
Answered : 1658 Questions
i have very mild upper abdomen pain but there no heartburn or blood stools as my stool is perfectly fine and no constipation, ive discomfort in my upper abdomen and flatulence with burps, when i eat its fine and after an hr after eating i get very very slight gnawing pain, my history is tht i had very bad food habits like after school i stayed home for 2 years and i skipped the whole breakfast and eat lunch at 4 pm thn some tiffin and thn very heavy dinner at 12 am night and sleep, now i realised my mistake and im taking breakfast , i have this pain since 1 and half month i went to doctor on december in saudi arabia where i live and they took h pylori test and it was negative , i tried dompirone (sme name like tht ) which failed to cure and then protozol jst for a week , they didnt work as they worked when i was taking them then it came bck. After many researches in google i came across non ulcer dyspepsia or fuctional dypepsia and the sypmtoms r quite matching, upper abdomen discomfort but nt very painful its very mild and gnawing pain as if im hungry thn very slight burning feeling which last fr 5 secs rarely , but no constipation or any other problem, i eat fine and sleep fine without problems but i alwys burp and flatulence, pls help me do i need endoscopy ?? THe pain is bit worse when im hungry or dont eat anything, im scared of endoscopy. Thank you,
Posted Mon, 18 Feb 2013 in Medicines and Side Effects
Answered by Dr. Mayank Bhargava 15 hours later
Welcome to XXXXXXX forum.

Let me know the associated symptoms along with abdominal pain and excessive flatulence.
Do you have fever/ nausea or vomiting/ frequent urge for defecation or loose motion and spasmodic abdominal pain?
Do you have abdominal heaviness/ excessive gargling sound?
Have you undergone ultrasound imaging in past?
Do you have positive family history of diabetes or thyroid disease?
Are you a smoker?

With the available described symptoms, there appears to be possibility of dyspepsia; which may be functional (as you have defined) or organic.
Presence of frequent burps and excessive flatulence is suggestive of diagnosis.
Organic means some sort of pathology in upper gastrointestinal tract.

Other possibilities could be decreased gastrointestinal motility (common in diabetes and hypothyroidism), cholecystitis, pancreatitis.
Frequent burping indicates decreased gastrointestinal motility (gas and food in spite of going ahead, coming back).
As the symptoms are persisting since one and a half month, possibility of gastrointestinal tract infection should also be kept in mind.

You should consult with your treating doctor/ XXXXXXX medicine specialist and should go for thorough check up.
You should go for complete hemogram, serum amylase, liver function test, and ultrasound imaging (if not done previously).
You have already undergone endoscopy along with H. Pylori test and which were found to be normal.
You should take complete antibiotic course, antispasmodics, probiotics on written prescription (if gastroenteritis is suspected). gastroenteritis is associated with all normal investigations and infection may persist for months without diagnosis and treatment.
You should continue with proton pump inhibitors along with prokinetics (which increases gastrointestinal tract motility) for relief of your symptoms.

Kindly follow these dietary restrictions:
1) Avoid tomatoes, citrus fruits, onion, garlic, oily and spicy food (particularly at night times), tea and coffee.
2) Avoid putting dough and boiled potatoes in refrigerator.
3) take less amount of legumes.
4) Only take 200 ml of milk; thats in the morning hours.
5) Keep difference of 3 hours between meals and sleep.
6) Take soft diet along with yogurt.

If all these mention symptoms are found to be normal and your condition won't improve then possibility of functional dyspepsia should be searched out.
Few patients have spastic smooth muscles and recurrent feeling of abdominal pain. Unfortunately no lab investigations is available for diagnosing this problem.
You should tale tricyclic antidepressants along with chlordiazepoxide and clidinium bromide on written prescription for getting relief (if not improved with above mentioned medicines).

Hope that helps.
Let me know if I can address any more concerns.
Take care,
Dr. Mayank Bhargava

Above answer was peer-reviewed by
Follow-up: Upper abdominal pain and excessive flatulence. No heartburn or blood in stool. Do I need endoscopy? 12 minutes later
Respected Doctor,

Let me answer your questions :

I do not have fever or nausea or bloody stools, my stools are completely normal and i go every morning frequently and its not loose or differ in color. i have no problem with excretion. However i have very very mild pain jst below the ribs or in the upper abdomen in mid section, i do not have heartburn or food coming back to the esophagus when you lie down, all i have is burp & flatulence and fullness feeling in the upper abdomen in mid section and sometimes after i eat after 1 or 45 mins i get very slight gnawing pain, thats all. When i drink buttermilk it feels so good sometimes, yes i do hear rumbling sound in morning and after i have my breakfast it subsides gradually. I didnt go for endoscopy as they doctor here told its not necessary and its only mandatory when u hav difficult swalling or heartburn or backing up in esophagus or bloody stools, however i had H pylori test for ulcer which came negative, he precribed me with Peptazol incase of GERD but it doesnt seems to mke any change, this pain doesnt affect my normal life but its annoying and feels weird when i get hungry, so i guess its non ulcer dyspepsia because i finished my high school in 2011 and now im sitting home idle doing nthng for 2 yrs and i had very bad food habits of skipping my breakfast for whole 2 yrs and thn eating lunch around 4 pm and thn tiffin and ending the day up with heavy meal around 12 am, now i realised the mistake and currently changing my lifestyle and having breakfast fr around 1 and half months, so pls let me know the reason of the gnawing mild pain in the mid upper abdomen and for the burps and flatulence, the other doctors suggest me for lifestyle changes and PPI, but i'd like to hear your suggestion as well as you have given me a detailed explanation, thank you so much doctor. Im 20 yrs old.
By the way i dont smoke or drink tea or coffee or anythng , no family history of thyroid problems or diabetes. Thank u doctor
Answered by Dr. Mayank Bhargava 18 minutes later
You haven't go for endoscopy yet now. Sorry for mistake.
With the described symptoms, possibility of gastroenteritis appears to be least.
Although you don't have heart burn, yet you must go for endoscopy for better clarification.
Relief of symptoms after buttermilk suggests some sort of upper gastrointestinal pathology.
You should follow dietary suggestions and prescribed medications as advised by me.
Let me know the result of endoscopy.
Don't get scared about endoscopy, Its a 3-4 minutes procedure under experienced hands.
Best regards,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
Follow-up: Upper abdominal pain and excessive flatulence. No heartburn or blood in stool. Do I need endoscopy? 7 minutes later
Aha, ok ill let you know, Is taking PPI a good advice ?? Is endoscopy better or a ct scan or xray ?? cos i dont think so they hav endoscopy in the hospital nearby my home as these endocopy procedures are done by big hospitals here which r far away from my city, do let me know any alternatives for endoscopy, when i get time ill go for endoscopy too but for now do you suggest any scan ?? but if its pathogen then i shoud have the urge to vomit, but i dont feel tht at all except for fullness ^^ Anyways for more clarificatiosn ill do as u stated, awaiting your reply, will PPI work too ??
Answered by Dr. Mayank Bhargava 34 minutes later
You can take PPI safely for 5 years. Whatever side effects have been defined with PPI, they are confined to animals not human beings.
Endoscopy is the appropriate investigations as compared to CT scan and x XXXXXXX
As such there is no alternative to endoscopy.
Meanwhile, you can go for ultrasound imaging to rule out cholecystitis and pancreatitis.
For getting relief from fullness, you should take prokinetics such as Itopride, levosulpiride and cinitapride along with PPI.
Wishing a speedy recovery.
Dr. Mayank Bhargava
Above answer was peer-reviewed by
Follow-up: Upper abdominal pain and excessive flatulence. No heartburn or blood in stool. Do I need endoscopy? 3 minutes later
Aha, thank you so much doctor, ill do it soon, may i know wht PPI cando ?? i mean whts the use of PPI ?? Thank you
Answered by Dr. Mayank Bhargava 4 minutes later
Dyspepsia is a broad term and it indicates some sort of involvement of gastric mucosa as well.
PPI helps in acid secretion and helps in getting relief.
Gastric problems are not always associated with ulcer or erosions. Many of times, endoscopy is normal while patients has dyspeptic symptoms.
PPI helps in such cases.
Take care,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
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