When Your Endoscopy Is Normal but Your Stomach Still Isn't Right

Even when tests are normal, the discomfort is real

Key points in 30 seconds

1. Even after tests for indigestion, more than three in four people get no clear cause.
2. It's a problem with how the stomach moves and senses, not its structure, so tests don't pick it up. It's not in your head.
3. About one in 12 to 15 adults has it.
4. In a trial of 278 people, acupuncture did better than sham acupuncture, and the effect lasted up to 12 weeks.
5. But if you're losing weight or have black stools, an endoscopy comes before seeing us.

What we often hear

• "I've had two endoscopies, and they say nothing's wrong."
• "Every time I eat, I feel bloated, like the food is stuck."
• "I get full after just a little, so I always leave food on my plate."
• "I live on digestive pills, but they only help for a while."
• "They say it's nerves, and it hurts to feel like I'm being told I'm faking it."

Many people come to us feeling even more frustrated after being told their tests show nothing wrong.

Here's what happens when you visit us

• First, we check whether you need tests. If you're losing weight, having trouble swallowing, have black stools, or the symptoms started for the first time in middle age or later, an endoscopy comes before our treatment.
• We work out which type you have. Whether you feel bloated after meals, or have a burning stomach even when it's empty. Treatment depends on which path you're on.
• We examine your abdomen by hand. The less an illness shows up in numbers, the more valuable a hands-on exam becomes.
• We don't look at the stomach alone. We also ask about your sleep, stress and how fast you eat.

Why doesn't it show up on tests?

When people get tested for indigestion, more than three in four have nothing that could explain it. When this kind of indigestion lasts more than six months, it's called functional dyspepsia. A study pooling about 250,000 people in 40 countries found it in about 8.4% of adults, or one in 12 to 15.

"Functional" doesn't mean you're faking it. It means the stomach looks fine but there's a problem with how it moves and how it senses. An endoscopy looks at shape, so it can't pick that up. Today, digestive medicine sees this as a problem in the connection between the gut and the brain. And that connection works hand in hand with sleep and stress. Not treating digestion as a stomach-only problem is something Korean medicine has done for a long time.

What the acupuncture research shows

In one trial, 278 people whose main symptom was fullness after meals were split into two groups. One group got real acupuncture and the other got sham acupuncture, 12 sessions over 4 weeks. Real acupuncture did better on both of the main measures, and the effect continued for up to 12 weeks after treatment ended.

There are two reasons this result stands out. The comparison was sham acupuncture: real acupuncture beat people who believed they were getting acupuncture, not people who got nothing. And it was published in a major American internal medicine journal. The claim that "there's no proper research on acupuncture" is no longer true, at least for this condition.

How far has herbal medicine been confirmed?

Yukgunja-tang (Rikkunshito) has been through two trials against a placebo in which neither the doctors nor the patients knew who was taking which. It's rare in itself for herbal medicine to be put to that kind of test.

In the first trial, 247 people took it for 8 weeks. On the overall rating, it leaned toward doing better than the placebo, but not by enough to rule out chance, while pain in the pit of the stomach clearly improved. In the second trial, symptoms clearly improved, and the improvement moved together with a drop in anxiety. A stomach medicine moving together with a mood measure fits exactly with the "gut-brain connection" above.

This is where our way of using herbal medicine comes from. We don't give one standardized product to everyone. We look at your type, what feels stiff or tender when we examine your abdomen, and what tests show, and make up a prescription that fits you.

What we want to be clear about

In the Yukgunja-tang trials, even the main outcome didn't show a clear difference. "It helps with some symptoms" is the accurate way to put it.

So we don't rely on a single standardized product; we tailor the prescription to your type and abdominal exam. The acupuncture trial results also come from the type with fullness after meals, so we don't apply them as-is to people whose main symptom is heartburn.

What changes

Finishing a whole bowl of rice. Not worrying ahead of time about the day after a work dinner. No longer carrying digestive pills in your bag.

And one more thing: knowing that you weren't faking it.

Response varies from person to person depending on the type of symptoms, how long you've had them, and your sleep and stress.

Come see us if you

• Still feel bloated even though your endoscopy was normal
• Get full after a little and always leave food
• Live on digestive pills
• Always get indigestion when you're stressed

On the day, we start by working out your type. But if you're losing weight, have black stools or have trouble swallowing, an endoscopy comes before seeing us. In that case, we'll first tell you where to get tested.

Sources for this article

Source	What was studied	Findings
Yang et al., 2020	278 people with fullness after meals, real vs. sham acupuncture (American internal medicine journal)	Real acupuncture better on both main measures, effect lasted 12 weeks
Tominaga et al., 2018	Trial comparing Yukgunja-tang with placebo	Symptoms clearly improved, moving together with less anxiety
Suzuki et al., 2014	Yukgunja-tang vs. placebo, 247 people for 8 weeks	No clear difference on overall rating; clear improvement in pain in the pit of the stomach
Lee et al., 2024	Pooled analysis of 44 studies, about 256,000 people in 40 countries	Adult prevalence about 8.4%, more common in women than men
Ford et al., 2020	Review of functional dyspepsia	No causal lesion in more than three-quarters of indigestion cases; described as a gut-brain connection problem

References

1. Yang JW, Wang LQ, Zou X, Yan SY, Wang Y, Zhao JJ, Tu JF, Wang J, Shi GX, Hu H, Zhou W, Du Y, Liu CZ. Effect of acupuncture for postprandial distress syndrome: a randomized clinical trial. Annals of Internal Medicine. 2020;172(12):777-785. doi:10.7326/M19-2880. PMID: 32422066

2. Tominaga K, Sakata Y, Kusunoki H, et al. Rikkunshito simultaneously improves dyspepsia correlated with anxiety in patients with functional dyspepsia: a randomized clinical trial (the DREAM study). Neurogastroenterology & Motility. 2018;30(6):e13319. doi:10.1111/nmo.13319

3. Suzuki H, Matsuzaki J, Fukushima Y, et al. Randomized clinical trial: rikkunshito in the treatment of functional dyspepsia — a multicenter, double-blind, randomized, placebo-controlled study. Neurogastroenterology & Motility. 2014;26(7):950-961. doi:10.1111/nmo.12348. PMID: 24766295

4. Lee K, Kwon C, Yeniova AÖ, et al. Global prevalence of functional dyspepsia according to Rome criteria, 1990-2020: a systematic review and meta-analysis. Scientific Reports. 2024;14:4172. doi:10.1038/s41598-024-54716-3

5. Ford AC, Mahadeva S, Carbone MF, Lacy BE, Talley NJ. Functional dyspepsia. Lancet. 2020;396(10263):1689-1702. doi:10.1016/S0140-6736(20)30469-4. PMID: 33049222

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If your endoscopy was normal but you're still uncomfortable, come see us. We'll start by finding what's getting in the way.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.