Food is a source of energy and nutrition, pleasure and guilt, comfort and distress. For many of us, overindulging in favorite foods can come back to haunt us, not just as the regret of excess calories consumed, but as stomach pain, gas, bloating and acid bubbling up from below.

Everyone experiences stomach pain occasionally, the result of overloading the digestive system with a big meal, emotional upset, physical stress or an illness. Short-term, occasional problems require simple self-help measures. If stomach upset or pain become chronic, however, causing discomfort over a period of weeks or months, it’s time to visit your doctor to identify the problem.

Millions of Americans suffer from common gastrointestinal complaints including ulcers, gastroesophageal reflux disease and irritable bowel syndrome. Your physician can identify your specific problem and suggest practical lifestyle changes and medications if necessary to manage your diagnosis. It’s also important to rule out less common but more serious conditions.

Peptic Ulcer Disease

Ulcers in the intestinal tract feel like a burning, aching or gnawing pain in the stomach. The pain is caused by open sores either in the lining of the stomach (a gastric ulcer) or the small intestine (a duodenal ulcer). As well as causing pain, ulcers can bleed and lead to serious blood loss. The pain from ulcers is often sporadic, lasting for several days at a time and then disappearing for a few weeks only to flare up again. Ulcer pain tends to occur on an empty stomach before meals or at night, and is often relieved by eating.

In the past ulcers were frequently treated with antacids. They can provide temporary relief of the pain from the ulcer. The real cause of ulcers is most often an infectious organism called Helicobacter pylori (H pylori). This bacteria can lead to ulceration in the stomach or intestines. Physicians can prescribe antibiotics and actually cure ulcers. One study found that after treatment with antibiotics, recurrence rates dropped to 10 percent after one year. Without antibiotics, patients treated only with acid-blocking drugs have a recurrence rate of 85 percent.

Almost all duodenal ulcers and about 80 percent of gastric ulcers are caused by H. pylori. A smaller number of gastric ulcers are caused by irritation to the stomach lining from things such as overuse of aspirin and other NSAIDs (nonsteroidal antiinflammatory drugs). Stress and alcoholism are also possible causes of stomach ulceration.

In the United States, 400,000 new cases of peptic ulcer disease are diagnosed each year. Men face a higher lifetime risk of 10 percent compared with 4 percent for women. When symptoms appear for several weeks, the doctor typically runs a series of tests to see if an ulcer is the problem. A number of tests, including breath and blood tests, are available to check for H. pylori infection. If your doctor suspects an ulcer he or she will probably test for infection and prescribe antibiotics if the test is positive.

With an effective cure available, no one need suffer chronic ulceration or the pain that accompanies it.

Gastroesophageal Reflux Disease (GERD)

Many people get occasional heartburn from spicy or acidic foods. When heartburn occurs on a regular basis, acid reflux disease may be to blame. Gastroesophageal Reflux Disease, or acid reflux, shows up after meals or in the night as chronic heartburn. When food is swallowed, a muscle at the bottom of the esophagus opens to allow the food to enter. The muscle then closes to keep food and acids produced by the stomach in the stomach. If that muscle weakens, food and acid can back up into the esophagus. Acid causes discomfort and irritation, and eventually can damage the lining of the esophagus. As most people know, acid reflux is more likely to happen when you’re lying down after a big meal. One out of five American adults experience heartburn at least once a week. For many individuals, over-the-counter antacids reduce the acid formation enough to help deal with the symptoms. Patients with more serious and frequent symptoms should see their doctor who might decide to prescribe a stronger acid-blocking drug.

The class of drugs known as proton pump inhibitors (PPIs) block the final step in acid production in the stomach. Some examples of drug trade names in the PPI category are Prilosec, Prevacid, Nexium and Aciphex. PPIs can lower acid production in the stomach by up to 90 percent. Decreased acid means less reflux pain, but to be effective these drugs must be taken regularly and can be expensive.

There are also a number of lifestyle changes that might improve symptoms. Patients are advised not to smoke and to limit spicy and acidic foods. Cutting back on alcohol, caffeine and carbonated drinks is also recommended. Food changes such as lower total fat content and smaller meals over the course of the day may also help. Those who suffer from GERD should avoid eating large meals and eating any meal close to bedtime. Overall reduction of weight can be very effective in reducing GERD symptoms. Finally, because gravity plays a role in reflux disease, using extra pillows or even propping the bed up a few extra inches helps some people.

Irritable Bowel Syndrome (IBS)

Chronic abdominal pain, nausea, excess gas and problems with bowel movements are all signals of Irritable Bowel Syndrome, or IBS. IBS may lead to either constipation or diarrhea, or a cycle of both. The cause for the disorder is not completely understood, but it more commonly occurs in the younger population. Unlike ulcers and reflux disease, IBS is common among children and teens as well as adults. It’s less often seen after age 65. One community study found that 6 to 14 percent of middle and high school students had IBS. Although there’s no cure for IBS, treatment focuses on diet and lifestyle changes.

There is no cure for the syndrome, but medication may be prescribed for treating specific symptoms. Typically the main concerns are either constipation or diarrhea. When constipation is the main problem, an increase in dietary fiber may be helpful. High-fiber foods such as fruits, vegetables, legumes and whole grains should be increased gradually. A sudden change will increase gas and discomfort. Patients who have trouble getting enough fiber from the diet may use a fiber supplement such as psyllium. Patients who have chronic diarrhea are advised to cut back on caffeine, alcohol, sorbitol, and fructose. These diet changes can also relieve gassiness.

Because of the complex interactions between brain and gut, managing stress levels can help. Stress is an inevitable part of life for most people. Patients are encouraged to try to identify situations that cause stomach pain and either minimize their exposure to these events or learn relaxation techniques to help cope with stress.

Persistent stomach pain, intestinal pain or gastric distress should not be ignored. Many problems can be taken care of with the right medication. Others can be managed and symptoms kept under control. Treatment can improve your quality of life and overall health.

Michelle Herbert, PharmD, CDE